MEDICARE: AMY ELIZABETH COONAN LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA 60241005	WA

General Provider Information

NPI Number	:	1053696088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ELIZABETH COONAN LMP

Provider Business Mailing Address
First Line	:	917 TIEDEMAN RD SW
Second Line	:
City	:	LAKEBAY
State	:	WA
Zip	:	98349-9453
Country	:	US
Telephone Number	:	253-720-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	14216 92ND AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98329-8710
Country	:	US
Telephone Number	:	253-720-6877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	01/30/2025

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