Provider Demographics
NPI:1740585496
Name:PALMER, AMANDA D (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:PALMER
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 1:6714 NW 16TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3975
Mailing Address - Country:US
Mailing Address - Phone:727-709-8226
Mailing Address - Fax:
Practice Address - Street 1:6714 NW 16TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3975
Practice Address - Country:US
Practice Address - Phone:727-709-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist