Provider Demographics
NPI:1295206076
Name:SMITH, AMANDA LASHAE (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LASHAE
Last Name:SMITH
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 1:4521 STANDING ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:TN
Mailing Address - Zip Code:37726-5013
Mailing Address - Country:US
Mailing Address - Phone:931-267-9063
Mailing Address - Fax:
Practice Address - Street 1:70 E SECOND ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4564
Practice Address - Country:US
Practice Address - Phone:931-267-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11881OtherLICENSED MASSAGE THERAPIST