Provider Demographics
NPI:1730518127
Name:SWINK, AMY Y (LMBT NC 13334)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:Y
Last Name:SWINK
Suffix:
Gender:F
Credentials:LMBT NC 13334
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 3RD AVE SE STE 102
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4036
Mailing Address - Country:US
Mailing Address - Phone:828-328-3627
Mailing Address - Fax:
Practice Address - Street 1:945 3RD AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4036
Practice Address - Country:US
Practice Address - Phone:828-328-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13334225700000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13334OtherNORTH CAROLINA BOARD OF MASSAGE AND BODYWORK THERAPY