MEDICARE: AMANDA LEE ROEBUCK L.M.P., A.P.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00023004	WA

General Provider Information

NPI Number	:	1629285101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEE ROEBUCK L.M.P., A.P.P.

Provider Business Mailing Address
First Line	:	1016 SAN FRANCISCO AVE NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4074
Country	:	US
Telephone Number	:	360-480-0342
Fax Number	:	360-943-6860

Provider Business Practice Location Address
First Line	:	1016 SAN FRANCISCO AVE NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4074
Country	:	US
Telephone Number	:	360-480-0342
Fax Number	:	360-943-6860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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