Provider Demographics
NPI:1013396894
Name:TITUS, AMBER (LMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:TITUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111S SPRING STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823
Mailing Address - Country:US
Mailing Address - Phone:814-441-4610
Mailing Address - Fax:
Practice Address - Street 1:111 S SPRING STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823
Practice Address - Country:US
Practice Address - Phone:814-441-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist