Provider Demographics
NPI:1811714314
Name:AMENSON, PAUL (LMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:AMENSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15325 BEAVER MARSH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-9779
Mailing Address - Country:US
Mailing Address - Phone:360-305-0378
Mailing Address - Fax:
Practice Address - Street 1:BARKLEY MASSAGE AND CHIROPRACTIC
Practice Address - Street 2:2930 NEWMARKET ST. #115
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-656-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61592651225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist