Provider Demographics
NPI:1750887840
Name:AMANDA HALL, LMP
Entity type:Organization
Organization Name:AMANDA HALL, LMP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LMP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-798-7625
Mailing Address - Street 1:300 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3214
Mailing Address - Country:US
Mailing Address - Phone:360-798-7625
Mailing Address - Fax:360-529-0691
Practice Address - Street 1:300 E 24TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3214
Practice Address - Country:US
Practice Address - Phone:360-798-7625
Practice Address - Fax:360-529-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty