Individual
AMANDA LONGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2236 CALLANAN ST, SHELTON, WA 98584-1904
(360) 490-0498
Mailing address
2236 CALLANAN ST, SHELTON, WA 98584-1904
(360) 490-0498
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60568438
WA
Other
Enumeration date
09/11/2015
Last updated
09/11/2015
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