Individual
AMANDA LYNN BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
5710 SW DAISY ST, PORT ORCHARD, WA 98367-7350
(360) 649-2461
Mailing address
PO BOX 358, BURLEY, WA 98322-0358
(360) 649-2461
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 60137523
WA
Other
Enumeration date
04/08/2010
Last updated
04/08/2010
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