MEDICARE: AMANDA LOIS HARRINGTON LMT

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	0019017171	VA

General Provider Information

NPI Number	:	1275260507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LOIS HARRINGTON LMT

Provider Business Mailing Address
First Line	:	3103 RED ROCK RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-4641
Country	:	US
Telephone Number	:	978-876-3084
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 COLONIAL AVE SW STE G
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3100
Country	:	US
Telephone Number	:	978-876-3084
Fax Number	:

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

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	08/05/2022

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