Provider Demographics
NPI:1407060858
Name:FISH, AMANDA (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:FISH
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 1:836 NE 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-2754
Mailing Address - Country:US
Mailing Address - Phone:352-208-3606
Mailing Address - Fax:
Practice Address - Street 1:850 NE 36TH TER
Practice Address - Street 2:SUITE A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-2050
Practice Address - Country:US
Practice Address - Phone:352-694-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 36492172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist