Provider Demographics
NPI:1942896790
Name:SPENCE, AMANDA (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SPENCE
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 1:2918 LEIPERS FORK TRL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-2989
Mailing Address - Country:US
Mailing Address - Phone:615-775-4129
Mailing Address - Fax:
Practice Address - Street 1:2918 LEIPERS FORK TRL
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-2989
Practice Address - Country:US
Practice Address - Phone:615-775-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist