Provider Demographics
NPI:1508463316
Name:WOODS, AMANDA LYNNE (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:WOODS
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 1:10608 GREENBRIAR CHASE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3211
Mailing Address - Country:US
Mailing Address - Phone:850-217-9835
Mailing Address - Fax:
Practice Address - Street 1:3916 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1600
Practice Address - Country:US
Practice Address - Phone:850-217-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK179550225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist