Provider Demographics
NPI:1275260507
Name:HARRINGTON, AMANDA LOIS (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOIS
Last Name:HARRINGTON
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 1:3103 RED ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-4641
Mailing Address - Country:US
Mailing Address - Phone:978-876-3084
Mailing Address - Fax:
Practice Address - Street 1:2302 COLONIAL AVE SW STE G
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3100
Practice Address - Country:US
Practice Address - Phone:978-876-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist