Provider Demographics
NPI:1174364541
Name:MORROW, AMANDA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MORROW
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MAGNOLIA DR STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1638
Mailing Address - Country:US
Mailing Address - Phone:618-978-7755
Mailing Address - Fax:
Practice Address - Street 1:108 MAGNOLIA DR STE A
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1638
Practice Address - Country:US
Practice Address - Phone:618-978-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-01
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.003137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist