Provider Demographics
NPI:1497901326
Name:BOWMAN, AMANDA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:BOWMAN
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 1:820 E PARK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2610
Mailing Address - Country:US
Mailing Address - Phone:850-224-2639
Mailing Address - Fax:850-385-3217
Practice Address - Street 1:820 E PARK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2610
Practice Address - Country:US
Practice Address - Phone:850-224-2639
Practice Address - Fax:850-385-3217
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51953225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist