Provider Demographics
NPI:1063871085
Name:BAHENA, AMBER (LMT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BAHENA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17720 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-7583
Mailing Address - Country:US
Mailing Address - Phone:360-944-4437
Mailing Address - Fax:360-944-3925
Practice Address - Street 1:17720 SE MILL PLAIN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-7583
Practice Address - Country:US
Practice Address - Phone:360-944-4437
Practice Address - Fax:360-944-3925
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60557079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist