Provider Demographics
NPI:1255196218
Name:LAPOLLA, AMBER MARIE (PTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:LAPOLLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:451 SW SEDGWICK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6447
Mailing Address - Country:US
Mailing Address - Phone:360-291-7944
Mailing Address - Fax:
Practice Address - Street 1:451 SW SEDGWICK RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-291-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61149285225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant