Provider Demographics
NPI:1851905764
Name:ALVAREZ, AMANDA (LMT, MLD-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LMT, MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221761
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-1761
Mailing Address - Country:US
Mailing Address - Phone:518-330-7039
Mailing Address - Fax:
Practice Address - Street 1:2709 27TH WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6706
Practice Address - Country:US
Practice Address - Phone:518-330-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43470225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist