Provider Demographics
NPI:1265190623
Name:NORRIS, SAMANTHA MICHAEL (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MICHAEL
Last Name:NORRIS
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 1:2305 NE 139TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3017
Mailing Address - Country:US
Mailing Address - Phone:360-831-1158
Mailing Address - Fax:
Practice Address - Street 1:104 GRAND BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7707
Practice Address - Country:US
Practice Address - Phone:360-695-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61204614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty