Provider Demographics
NPI:1255840641
Name:THOMPSON, AMANDA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:THOMPSON
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 1:1151 COLORADO BLVD APT 204
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3638
Mailing Address - Country:US
Mailing Address - Phone:720-518-4301
Mailing Address - Fax:
Practice Address - Street 1:3035 SOUTH PARKER RD.
Practice Address - Street 2:560 BUILDING E
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-722-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0020683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist