Provider Demographics
NPI:1447418611
Name:HALEY, AMANDA HYATT (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HYATT
Last Name:HALEY
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 1:500 S CYPRESS RD # 4
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7141
Mailing Address - Country:US
Mailing Address - Phone:954-969-8800
Mailing Address - Fax:
Practice Address - Street 1:500 S CYPRESS RD # 4
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7141
Practice Address - Country:US
Practice Address - Phone:954-969-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist