Healthcare Provider Details

I. General information

NPI: 1770010134
Provider Name (Legal Business Name): AMANDA MAE MCDOWELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 S BINKLEY ST STE 101
SOLDOTNA AK
99669-8061
US

IV. Provider business mailing address

530 W RIVERVIEW AVE
SOLDOTNA AK
99669-7709
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-0801
  • Fax:
Mailing address:
  • Phone: 907-394-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number114484
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: