Healthcare Provider Details

I. General information

NPI: 1093017469
Provider Name (Legal Business Name): AMBER ISENBERG L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 NE NORTHGATE WAY
SEATTLE WA
98125-7312
US

IV. Provider business mailing address

15108 SE 179TH ST APT. 3C
RENTON WA
98058-9092
US

V. Phone/Fax

Practice location:
  • Phone: 206-784-0737
  • Fax:
Mailing address:
  • Phone: 253-951-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 00016201
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: