Healthcare Provider Details

I. General information

NPI: 1316823248
Provider Name (Legal Business Name): AMY KATHLEEN LIWAG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4927 NE 30TH AVE
PORTLAND OR
97211-7007
US

IV. Provider business mailing address

4220 NE SIMPSON CT
PORTLAND OR
97218-1450
US

V. Phone/Fax

Practice location:
  • Phone: 323-420-7462
  • Fax:
Mailing address:
  • Phone: 323-420-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29036
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: