Provider Demographics
NPI:1023307493
Name:EDWARDS, AMANDA JEMIMA (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEMIMA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:JEMIMA
Other - Last Name:LOUNSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3600 NW 43RD ST
Practice Address - Street 2:#3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8137
Practice Address - Country:US
Practice Address - Phone:352-642-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist