Provider Demographics
NPI:1710346143
Name:WOYNA, AMIE (LMT #21801)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:WOYNA
Suffix:
Gender:F
Credentials:LMT #21801
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-6010
Mailing Address - Country:US
Mailing Address - Phone:541-210-0226
Mailing Address - Fax:
Practice Address - Street 1:319 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-6010
Practice Address - Country:US
Practice Address - Phone:541-210-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21801225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist