MEDICARE: AMANDA BIRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33025213	OH

General Provider Information

NPI Number	:	1003705096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BIRT

Provider Business Mailing Address
First Line	:	3588 SARGENT RD
Second Line	:
City	:	GUYSVILLE
State	:	OH
Zip	:	45735-9540
Country	:	US
Telephone Number	:	813-479-8670
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 RICHLAND AVE
Second Line	:
City	:	ATHENS
State	:	OH
Zip	:	45701-3700
Country	:	US
Telephone Number	:	813-479-8670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/02/2025

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Directions to “ AMANDA BIRT ” Practice Location

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