Healthcare Provider Details

I. General information

NPI: 1588573471
Provider Name (Legal Business Name): AMY B.L. PHEASANT MTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 N WORTHEN ST STE 100
WENATCHEE WA
98801-6137
US

IV. Provider business mailing address

18 N WORTHEN ST STE 100
WENATCHEE WA
98801-6137
US

V. Phone/Fax

Practice location:
  • Phone: 509-665-9518
  • Fax:
Mailing address:
  • Phone: 509-665-9518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number70171892
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: