Provider Demographics
NPI:1790511764
Name:AMENDOLARE, TAMARA TRAVERS (LMT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:TRAVERS
Last Name:AMENDOLARE
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 1:3818 S AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-8458
Mailing Address - Country:US
Mailing Address - Phone:509-423-3475
Mailing Address - Fax:
Practice Address - Street 1:1215 E 1ST ST STE E
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4323
Practice Address - Country:US
Practice Address - Phone:509-423-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012982225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist