Provider Demographics
NPI:1912763350
Name:YODER, AMANDA F (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:F
Last Name:YODER
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 1:1009 HIGHWAY 2 STE D
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2713
Mailing Address - Country:US
Mailing Address - Phone:406-544-1831
Mailing Address - Fax:
Practice Address - Street 1:1009 HIGHWAY 2 STE D
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2713
Practice Address - Country:US
Practice Address - Phone:406-544-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-4265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist