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General NPI Number Information
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NPI Number | 1043036312
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Entity Type | Individual
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Provider Name | AMANDA ECKERT LMT
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 104 CONSTITUTION DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-7889
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Country | US
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Telephone | 478-333-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 308 BRIARMOOR DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-7950
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Country | US
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Telephone | 843-206-9901
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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 | MT014518
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License Number State | GA
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