Provider Demographics
NPI:1306336896
Name:BADER, AMY L (LMT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:BADER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:RUPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4903 112TH ST. SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:425-244-0628
Mailing Address - Fax:425-740-1737
Practice Address - Street 1:18122 SR 9 SE
Practice Address - Street 2:SUITE D
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296
Practice Address - Country:US
Practice Address - Phone:425-244-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60692358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist