Healthcare Provider Details

I. General information

NPI: 1134054539
Provider Name (Legal Business Name): AMANDA KAY SWEARENGIN CMT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29303 195TH LN
ISLE MN
56342-4818
US

IV. Provider business mailing address

29303 195TH LN
ISLE MN
56342-4818
US

V. Phone/Fax

Practice location:
  • Phone: 612-877-2933
  • Fax:
Mailing address:
  • Phone: 612-877-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-LMT-LIC-24315
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: