Provider Demographics
NPI:1174754816
Name:NECKLAUS, AMANDA (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:NECKLAUS
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 1:624 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2004
Mailing Address - Country:US
Mailing Address - Phone:125-659-9279
Mailing Address - Fax:
Practice Address - Street 1:624 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2004
Practice Address - Country:US
Practice Address - Phone:125-659-9279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist