Provider Demographics
NPI:1477108132
Name:TEMPLETON, AMANDA KAY (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KAY
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1421 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1939
Mailing Address - Country:US
Mailing Address - Phone:952-473-1850
Mailing Address - Fax:
Practice Address - Street 1:1421 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1939
Practice Address - Country:US
Practice Address - Phone:952-473-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1407028939Medicaid