Doctor Name: | AMBER WAGSTAFF |
NPI Number: | 1104234517 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 20500 |
Business Practice Address: | 1034 N 3rd St Suite 1 Coeur D Alene, ID - 838143145 |
Business Phone Number: | 2089167971 |
Business Fax Number: | |
Mailing Address: | 1034 N 3rd St, Suite 1 COEUR D ALENE |
State: | ID |
Postal Code: | 838143145 |
Phone Number: | 2089167971 |
Fax Number: | |
NPI Enumeration Date: | 07/29/2014 |
NPI Last Update Date: | 09/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 20500 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |