Provider Demographics
NPI:1669911913
Name:YANG, AMY (MASSAGE CERTIFICATE)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:MASSAGE CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MAGNOLIA AVE WEST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4913
Mailing Address - Country:US
Mailing Address - Phone:612-670-5510
Mailing Address - Fax:651-488-2885
Practice Address - Street 1:78 MAGNOLIA AVE WEST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-4913
Practice Address - Country:US
Practice Address - Phone:612-670-5510
Practice Address - Fax:651-488-2885
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist