Healthcare Provider Details

I. General information

NPI: 1164355343
Provider Name (Legal Business Name): AMANDA JOYCE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52615 SUN DANCE DR UNIT 2
FORT HOOD TX
76544-1019
US

IV. Provider business mailing address

52615 SUN DANCE DR UNIT 2
FORT HOOD TX
76544-1019
US

V. Phone/Fax

Practice location:
  • Phone: 254-248-5746
  • Fax:
Mailing address:
  • Phone: 254-248-5746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT149157
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: