Provider Demographics
NPI:1861821647
Name:SCHWARTZ, AMANDA (LMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BIRCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:10818 NE COXLEY DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6163
Mailing Address - Country:US
Mailing Address - Phone:360-949-0500
Mailing Address - Fax:
Practice Address - Street 1:10818 NE COXLEY DR
Practice Address - Street 2:SUITE I
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6163
Practice Address - Country:US
Practice Address - Phone:360-949-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60409355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist