MEDICARE: MS. AMANDA DEAN SIMS 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	174400000X	Specialist	MA45785	FL

General Provider Information

NPI Number	:	1912185323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA DEAN SIMS LMT

Provider Business Mailing Address
First Line	:	3333 A ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-3030
Country	:	US
Telephone Number	:	850-276-3108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 WILSON AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4532
Country	:	US
Telephone Number	:	850-276-3108
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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