Provider Demographics
NPI:1245754001
Name:WILSON, AMBER MICHELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MICHELLE
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4680 CORDATA PKWY
Mailing Address - Street 2:NORTH CASCADES HEALTH AND REHAB
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-398-1966
Mailing Address - Fax:
Practice Address - Street 1:4860 CORDATA PKWY
Practice Address - Street 2:NORTH CASCADES HEALTH AND REHAB
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-398-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160434720225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant