Provider Demographics
NPI:1225592975
Name:HARDIN, AMANDA KAY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:HARDIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MANDY
Other - Middle Name:KAY
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1948 S GLENSTONE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2305
Mailing Address - Country:US
Mailing Address - Phone:417-812-5031
Mailing Address - Fax:
Practice Address - Street 1:1948 S GLENSTONE AVE STE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2305
Practice Address - Country:US
Practice Address - Phone:417-812-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018015048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist