Provider Demographics
NPI:1568837938
Name:ENRIQUEZ, AMY V (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:V
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:V
Other - Last Name:MUSGRAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:731 GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9701
Mailing Address - Country:US
Mailing Address - Phone:509-737-1461
Mailing Address - Fax:509-628-9643
Practice Address - Street 1:731 GAGE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9701
Practice Address - Country:US
Practice Address - Phone:509-737-1461
Practice Address - Fax:509-628-9643
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60603178225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist