MEDICARE: MRS. AMANDA LOVETT THOMPSON MMP, 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	MA34412	FL

General Provider Information

NPI Number	:	1841403771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LOVETT THOMPSON MMP, LMT,

Provider Business Mailing Address
First Line	:	PO BOX 82
Second Line	:
City	:	EAGLE LAKE
State	:	FL
Zip	:	33839-0082
Country	:	US
Telephone Number	:	863-294-8468
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 1ST ST S
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3903
Country	:	US
Telephone Number	:	863-294-8468
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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