Provider Demographics
NPI:1104140243
Name:CASSIDY, AMBER K (LMP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:K
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 CENTER BLVD SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-8748
Mailing Address - Country:US
Mailing Address - Phone:425-396-7778
Mailing Address - Fax:425-396-7097
Practice Address - Street 1:1 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:425-462-4330
Practice Address - Fax:425-462-4335
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60106180225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist