MEDICARE: AMANDA LYNN DOYLE 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	7501009537	MI

General Provider Information

NPI Number	:	1790323558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LYNN DOYLE LMT

Provider Business Mailing Address
First Line	:	34 DEER CREEK DR
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3647
Country	:	US
Telephone Number	:	765-421-1745
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 DEER CREEK DR
Second Line	:
City	:	FORT GRATIOT
State	:	MI
Zip	:	48059-3647
Country	:	US
Telephone Number	:	765-421-1745
Fax Number	:

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

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	12/11/2019

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