Provider Demographics
NPI:1780881631
Name:APPLE, SAMANTHA (LMP)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:APPLE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21525 NE 68TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-9098
Mailing Address - Country:US
Mailing Address - Phone:360-606-9270
Mailing Address - Fax:
Practice Address - Street 1:13025 NE FOURTH PLAIN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5651
Practice Address - Country:US
Practice Address - Phone:360-253-4285
Practice Address - Fax:503-253-9469
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0216136OtherL&I