Healthcare Provider Details

I. General information

NPI: 1538519970
Provider Name (Legal Business Name): AMY FLYNT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 9TH ST NW STE 1
WASHINGTON DC
20001-3361
US

IV. Provider business mailing address

1108 BEVERLEY DR
ALEXANDRIA VA
22302-2422
US

V. Phone/Fax

Practice location:
  • Phone: 202-408-4858
  • Fax:
Mailing address:
  • Phone: 703-868-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1505
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: