Provider Demographics
NPI:1477927002
Name:WENDT, AMANDA LEIGH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEIGH
Last Name:WENDT
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 1:221 S IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2529
Mailing Address - Country:US
Mailing Address - Phone:406-925-0947
Mailing Address - Fax:
Practice Address - Street 1:221 S IDAHO ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2529
Practice Address - Country:US
Practice Address - Phone:406-925-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-9617225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist