Provider Demographics
NPI:1831562677
Name:CUMMINGS, AMANDA JOY (LMP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:CUMMINGS
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 1:3000 NE 109TH AVE APT 59
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7248
Mailing Address - Country:US
Mailing Address - Phone:360-487-6539
Mailing Address - Fax:
Practice Address - Street 1:5512 NE 109TH CT STE I
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6175
Practice Address - Country:US
Practice Address - Phone:360-798-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60607980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist