Healthcare Provider Details

I. General information

NPI: 1639953201
Provider Name (Legal Business Name): AMANDA L KARBAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

IV. Provider business mailing address

2451 E BASELINE RD STE 100
GILBERT AZ
85234-2467
US

V. Phone/Fax

Practice location:
  • Phone: 480-304-5152
  • Fax: 480-603-4147
Mailing address:
  • Phone: 480-304-5152
  • Fax: 480-603-4147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18251
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: