Provider Demographics
NPI:1316690043
Name:METCALF, AMISSA (LMT, CLD, E-RYT500)
Entity type:Individual
Prefix:
First Name:AMISSA
Middle Name:
Last Name:METCALF
Suffix:
Gender:F
Credentials:LMT, CLD, E-RYT500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MESA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063-9064
Mailing Address - Country:US
Mailing Address - Phone:915-227-8094
Mailing Address - Fax:
Practice Address - Street 1:6919 DONIPHAN DR STE 7
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835-5529
Practice Address - Country:US
Practice Address - Phone:915-227-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
TXMT129940225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty