Provider Demographics
NPI:1376881276
Name:WAGENBLAST, AMBER M (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:M
Last Name:WAGENBLAST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2994
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2994
Mailing Address - Country:US
Mailing Address - Phone:509-888-3062
Mailing Address - Fax:509-888-3063
Practice Address - Street 1:528 E SPOKANE FALLS BLVD
Practice Address - Street 2:STE 401
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-5050
Practice Address - Country:US
Practice Address - Phone:509-435-0481
Practice Address - Fax:509-435-0485
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist