Healthcare Provider Details

I. General information

NPI: 1245511310
Provider Name (Legal Business Name): AMITA GUPTA LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY SUITE 620
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

702 NW 73RD ST
SEATTLE WA
98117-4953
US

V. Phone/Fax

Practice location:
  • Phone: 206-343-3325
  • Fax: 206-838-7330
Mailing address:
  • Phone: 206-353-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60141287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: