Provider Demographics
NPI:1639395163
Name:LEONARD, AMANDA G (NCMMT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:G
Last Name:LEONARD
Suffix:
Gender:F
Credentials:NCMMT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:G
Other - Last Name:CRAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCMMT
Mailing Address - Street 1:5935 TREOSTI PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-9138
Mailing Address - Country:US
Mailing Address - Phone:209-772-7926
Mailing Address - Fax:
Practice Address - Street 1:145 MANGILI RD
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-8400
Practice Address - Country:US
Practice Address - Phone:209-772-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist