Healthcare Provider Details

I. General information

NPI: 1073945275
Provider Name (Legal Business Name): AMANDA L NORDHOF L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 NORTH HIGHT STREET
COLUMBUS OH
43214
US

IV. Provider business mailing address

2814 INDIANOLA AVE
COLUMBUS OH
43202-2358
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-3800
  • Fax: 614-947-0358
Mailing address:
  • Phone: 614-517-6927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.020388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: