Provider Demographics
NPI:1437912821
Name:WESTFALL, AMANDA (LMBT, MMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WESTFALL
Suffix:
Gender:F
Credentials:LMBT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 BIMINI PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1718
Mailing Address - Country:US
Mailing Address - Phone:304-610-6996
Mailing Address - Fax:
Practice Address - Street 1:230 LINDSAY RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6725
Practice Address - Country:US
Practice Address - Phone:910-514-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13550225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist