Provider Demographics
NPI:1356575781
Name:WOODS, AMANDA VALERIE I (LMT)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:VALERIE
Last Name:WOODS
Suffix:I
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 1:919 CHESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4634
Mailing Address - Country:US
Mailing Address - Phone:850-590-5909
Mailing Address - Fax:
Practice Address - Street 1:919 CHESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4634
Practice Address - Country:US
Practice Address - Phone:850-590-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#29549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist