Healthcare Provider Details

I. General information

NPI: 1750682050
Provider Name (Legal Business Name): AMY JENNIFER BEAUFORD L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31659 NE 104TH ST
CARNATION WA
98014-9751
US

IV. Provider business mailing address

31659 NE 104TH ST
CARNATION WA
98014-9751
US

V. Phone/Fax

Practice location:
  • Phone: 425-614-8111
  • Fax:
Mailing address:
  • Phone: 425-614-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60184370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: