Provider Demographics
NPI:1073787131
Name:HAYDEN, SAMANTHA LYNNE (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LYNNE
Other - Last Name:HAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2505 E MAIN APT B303
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-7088
Mailing Address - Country:US
Mailing Address - Phone:253-370-6049
Mailing Address - Fax:
Practice Address - Street 1:4154 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4102
Practice Address - Country:US
Practice Address - Phone:360-399-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60014297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist