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NPI Code Detail

MEDICARE: MS. AMANDA LIBERTY LMT

MEDICARE:  MS. AMANDA  LIBERTY  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
1225700000XMassage TherapistMA62154FL

General Provider Information

NPI Number : 1942589247
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA LIBERTY LMT
Provider Business Mailing Address
First Line : 12795 SAN JOSE BLVD
Second Line : STE 9
City : JACKSONVILLE
State : FL
Zip : 32223-2669
Country : US
Telephone Number : 904-619-1587
Fax Number :
Provider Business Practice Location Address
First Line : 12795 SAN JOSE BLVD
Second Line : STE 9
City : JACKSONVILLE
State : FL
Zip : 32223-2669
Country : US
Telephone Number : 904-619-1587
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/04/2011

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Directions to “ MS. AMANDA LIBERTY LMT” Practice Location

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