Doctor Name: | AMY ELLEN BRATVOLD |
NPI Number: | 1629404629 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T. |
License Number: | MAS - 996 |
Business Practice Address: | 390 E Parkcenter Blvd Suite 130 Boise, ID - 837066662 |
Business Phone Number: | 2084339211 |
Business Fax Number: | 2084339241 |
Mailing Address: | 16083 Sw Upper Boones Ferry Rd, Suite 300 TIGARD |
State: | OR |
Postal Code: | 972247736 |
Phone Number: | 8002198835 |
Fax Number: | 5036399699 |
NPI Enumeration Date: | 09/23/2013 |
NPI Last Update Date: | 09/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MAS - 996 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
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. |