Provider Demographics
NPI:1437862885
Name:SCHROEDER, AMANDA JOY (CMT, LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 600564
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-0010
Mailing Address - Country:US
Mailing Address - Phone:651-442-2161
Mailing Address - Fax:
Practice Address - Street 1:6043 HUDSON RD STE 300K
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1017
Practice Address - Country:US
Practice Address - Phone:651-442-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44-01-MTL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist