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General NPI Number Information
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NPI Number | 1831239805
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Entity Type | Individual
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Provider Name | AMANDA LEIGH DALE LMT
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2180 A1A S SUITE 100
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-6591
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Country | US
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Telephone | 904-806-6846
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Fax | 904-471-6236
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Provider Business Mailing Address
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Address Line | 505 WHISPERING CIR APT 13
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-0842
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Country | US
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Telephone | 904-806-6849
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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 | MA 41898
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License Number State | FL
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