Healthcare Provider Details

I. General information

NPI: 1619236007
Provider Name (Legal Business Name): AMY LEEANN HENSLEY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12727 W 14TH AVE
AIRWAY HEIGHTS WA
99001-9409
US

IV. Provider business mailing address

9116 E SPRAGUE AVE 104
SPOKANE VALLEY WA
99206-3601
US

V. Phone/Fax

Practice location:
  • Phone: 509-244-4818
  • Fax:
Mailing address:
  • Phone: 509-217-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60185900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: