Provider Demographics
NPI:1013639806
Name:CROSS, AMANDA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:CROSS
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 1:2008 WILLAMETTE FALLS DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4673
Mailing Address - Country:US
Mailing Address - Phone:503-650-6494
Mailing Address - Fax:503-212-0446
Practice Address - Street 1:2008 WILLAMETTE FALLS DR STE 200A
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4673
Practice Address - Country:US
Practice Address - Phone:503-650-6494
Practice Address - Fax:503-212-0446
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist