Provider Demographics
NPI:1073924627
Name:GROFT, AMANDA MARIE (MASSAGE THERAPY)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:GROFT
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1898 SMITH STATION RD
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-8978
Mailing Address - Country:US
Mailing Address - Phone:717-630-1838
Mailing Address - Fax:
Practice Address - Street 1:1898 SMITH STATION RD
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-8978
Practice Address - Country:US
Practice Address - Phone:717-630-1838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist