Provider Demographics
NPI:1972808293
Name:LASHELLS, AMANDA RITA (LMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RITA
Last Name:LASHELLS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RITA
Other - Last Name:STETTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:4040 ORCHARD ST W
Practice Address - Street 2:100
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6606
Practice Address - Country:US
Practice Address - Phone:253-564-1560
Practice Address - Fax:253-564-4449
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60064396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist