Provider Demographics
NPI:1023209376
Name:SIMON, AMANDA MICHELLE (HHP, LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:SIMON
Suffix:
Gender:F
Credentials:HHP, LMT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MICHELLE
Other - Last Name:TOWNZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HHP, LMT
Mailing Address - Street 1:3100 MARYVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5119
Mailing Address - Country:US
Mailing Address - Phone:618-931-1000
Mailing Address - Fax:618-931-2737
Practice Address - Street 1:3100 MARYVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-5119
Practice Address - Country:US
Practice Address - Phone:618-931-1000
Practice Address - Fax:618-931-2737
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist