Provider Demographics
NPI:1194078477
Name:AMADOR, JULIE ANNE (LMT#14168)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:AMADOR
Suffix:
Gender:F
Credentials:LMT#14168
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7517
Mailing Address - Country:US
Mailing Address - Phone:541-613-0603
Mailing Address - Fax:
Practice Address - Street 1:1074 BEALL LN
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2717
Practice Address - Country:US
Practice Address - Phone:541-613-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist