Healthcare Provider Details

I. General information

NPI: 1487735635
Provider Name (Legal Business Name): AMANDA BROOKE LASSETTER-WHITE LMT NCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MCCURDY AVE N UNIT 1
RAINSVILLE AL
35986-4476
US

IV. Provider business mailing address

PO BOX 2031
RAINSVILLE AL
35986
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-2627
  • Fax: 256-638-2627
Mailing address:
  • Phone: 256-638-2627
  • Fax: 256-638-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number728
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: