Provider Demographics
NPI:1831510460
Name:PARRISH, AMY (LMBT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PARRISH
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 RED COCKADED CT
Mailing Address - Street 2:APT 303
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7185
Mailing Address - Country:US
Mailing Address - Phone:910-390-0345
Mailing Address - Fax:
Practice Address - Street 1:6317 OLEANDER DR
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3568
Practice Address - Country:US
Practice Address - Phone:910-390-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12611225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist