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General NPI Number Information
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NPI Number | 1003705096
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Entity Type | Individual
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Provider Name | AMANDA BIRT
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 507 RICHLAND AVE
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City | ATHENS
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State | OH
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Zip | 45701-3700
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Country | US
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Telephone | 813-479-8670
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Fax |
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Provider Business Mailing Address
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Address Line | 3588 SARGENT RD
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City | GUYSVILLE
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State | OH
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Zip | 45735-9540
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Country | US
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Telephone | 813-479-8670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33025213
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License Number State | OH
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