Provider Demographics
NPI:1508207259
Name:NAYFIELD, AMANDA NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:NAYFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 12TH STREET
Mailing Address - Street 2:#103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7420
Mailing Address - Country:US
Mailing Address - Phone:360-752-2673
Mailing Address - Fax:360-752-0271
Practice Address - Street 1:1514 12TH STREET
Practice Address - Street 2:#103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7420
Practice Address - Country:US
Practice Address - Phone:360-752-2673
Practice Address - Fax:360-752-0271
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60387686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist