Provider Demographics
NPI:1649587213
Name:WOODENLEG, AMANDA SOPHIE (LMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SOPHIE
Last Name:WOODENLEG
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 1:204 E LAUREL ST
Mailing Address - Street 2:#105
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4761
Mailing Address - Country:US
Mailing Address - Phone:360-441-2065
Mailing Address - Fax:
Practice Address - Street 1:204 E LAUREL ST
Practice Address - Street 2:#105
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4761
Practice Address - Country:US
Practice Address - Phone:360-441-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60177970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist