Provider Demographics
NPI:1861042764
Name:BURTON, AMANDA R (CMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:BURTON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 INDIANA AVE STE 47
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5573
Mailing Address - Country:US
Mailing Address - Phone:219-299-2628
Mailing Address - Fax:
Practice Address - Street 1:259 INDIANA AVE STE 47
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5573
Practice Address - Country:US
Practice Address - Phone:219-299-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21204324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist