Provider Demographics
NPI:1760628739
Name:HANSON, AMY AXT (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:AXT
Last Name:HANSON
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 1:923 N LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5510
Mailing Address - Country:US
Mailing Address - Phone:253-222-3651
Mailing Address - Fax:
Practice Address - Street 1:2520 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5328
Practice Address - Country:US
Practice Address - Phone:253-222-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058900225700000X
WA60058900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60058900OtherSTATE LICENSE