Provider Demographics
NPI:1982218244
Name:HARDY, AMANDA SUE (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:HARDY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:AMANDA HARDY
Mailing Address - Street 2:423 KELLY RD
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745
Mailing Address - Country:US
Mailing Address - Phone:678-477-8154
Mailing Address - Fax:
Practice Address - Street 1:AMANDA HARDY
Practice Address - Street 2:423 KELLY RD
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745
Practice Address - Country:US
Practice Address - Phone:678-477-8154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist