Provider Demographics
NPI:1760193478
Name:STOLZ, AMANDA (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STOLZ
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 1:30501 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-8714
Mailing Address - Country:US
Mailing Address - Phone:636-373-6098
Mailing Address - Fax:
Practice Address - Street 1:70 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:KEENESBURG
Practice Address - State:CO
Practice Address - Zip Code:80643-8064
Practice Address - Country:US
Practice Address - Phone:636-373-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-0024782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist