Healthcare Provider Details

I. General information

NPI: 1033448832
Provider Name (Legal Business Name): AMANDA L SCHAEFER PTA/LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 04/24/2023
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 165TH PL SE
BOTHELL WA
98012
US

IV. Provider business mailing address

2929 165TH PL SE
BOTHELL WA
98012
US

V. Phone/Fax

Practice location:
  • Phone: 734-323-9093
  • Fax:
Mailing address:
  • Phone: 734-323-9093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60111033
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60317301
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: