Provider Demographics
NPI:1609170968
Name:LUTZ, AIMEE MARIE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:MARIE
Last Name:LUTZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9775 STATE ROUTE 28 W
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-9715
Mailing Address - Country:US
Mailing Address - Phone:509-787-0385
Mailing Address - Fax:
Practice Address - Street 1:110 C ST SW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1207
Practice Address - Country:US
Practice Address - Phone:509-787-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00022756225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist