Provider Demographics
NPI:1275918336
Name:BROOKS, AMANDA CLAIRE (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLAIRE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:626 CORDOVA STREET SUITE 105
Mailing Address - Street 2:ADVANCED BODY SOLUTIONS
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-277-5525
Mailing Address - Fax:907-277-5526
Practice Address - Street 1:626 CORDOVA STREET SUITE 105
Practice Address - Street 2:ADVANCED BODY SOLUTIONS
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-277-5525
Practice Address - Fax:907-277-5526
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK934890225700000X
AK101387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist