MEDICARE: MRS. AMANDA G LEONARD NCMMT

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		CA

General Provider Information

NPI Number	:	1639395163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA G LEONARD NCMMT

Provider Business Mailing Address
First Line	:	5935 TREOSTI PL
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-9138
Country	:	US
Telephone Number	:	209-772-7926
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MANGILI RD
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8400
Country	:	US
Telephone Number	:	209-772-3930
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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