Provider Demographics
NPI:1972808293
Name:LASHELLS, AMANDA RITA (LMT, CLT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RITA
Last Name:LASHELLS
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RITA
Other - Last Name:STETTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:10663 SUNDIAL LN
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5137
Mailing Address - Country:US
Mailing Address - Phone:253-407-6930
Mailing Address - Fax:253-409-2579
Practice Address - Street 1:5800 SOUNDVIEW DR BLDG B
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2000
Practice Address - Country:US
Practice Address - Phone:253-407-6930
Practice Address - Fax:253-409-2579
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60064396225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist