Provider Demographics
NPI:1811755663
Name:AMANDA BOONE DBA TRUE MASSAGE
Entity type:Organization
Organization Name:AMANDA BOONE DBA TRUE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT MA55291
Authorized Official - Phone:850-792-4792
Mailing Address - Street 1:1813 JOHN SIMS PKWY E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2337
Mailing Address - Country:US
Mailing Address - Phone:850-792-4792
Mailing Address - Fax:888-315-8783
Practice Address - Street 1:1813 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2337
Practice Address - Country:US
Practice Address - Phone:850-792-4792
Practice Address - Fax:888-315-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty