Provider Demographics
NPI:1083372833
Name:SKELTON, AMANDA (CMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 LONE BLUFF WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1164
Mailing Address - Country:US
Mailing Address - Phone:765-427-0265
Mailing Address - Fax:
Practice Address - Street 1:2747 LONE BLUFF WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1164
Practice Address - Country:US
Practice Address - Phone:765-427-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist