Provider Demographics
NPI:1508384520
Name:ONG, AMANDA K (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:K
Last Name:ONG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 W NORTHERN AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1441
Mailing Address - Country:US
Mailing Address - Phone:480-621-0363
Mailing Address - Fax:
Practice Address - Street 1:5334 W NORTHERN AVE STE 325
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1441
Practice Address - Country:US
Practice Address - Phone:480-621-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ23245OtherMASSAGE THERAPY