Provider Demographics
NPI:1023727039
Name:RESCH, AMANDA NOELLE (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NOELLE
Last Name:RESCH
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 1:1675 AUGUST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1927
Mailing Address - Country:US
Mailing Address - Phone:631-678-1198
Mailing Address - Fax:
Practice Address - Street 1:1675 AUGUST RD
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1927
Practice Address - Country:US
Practice Address - Phone:631-678-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012582-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012582-01OtherNYS BOARD