Healthcare Provider Details

I. General information

NPI: 1033371042
Provider Name (Legal Business Name): AMANDA E TAPP L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NW MAPLE ST 111
ISSAQUAH WA
98027-8127
US

IV. Provider business mailing address

2210 132ND AVE SE 210
BELLEVUE WA
98005-3924
US

V. Phone/Fax

Practice location:
  • Phone: 425-394-1200
  • Fax: 425-394-0100
Mailing address:
  • Phone: 206-356-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00024452
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: