Provider Demographics
NPI:1487735635
Name:LASSETTER-WHITE, AMANDA BROOKE (LMT NCMT)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:BROOKE
Last Name:LASSETTER-WHITE
Suffix:
Gender:F
Credentials:LMT NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2031
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986
Mailing Address - Country:US
Mailing Address - Phone:256-638-2627
Mailing Address - Fax:256-638-2627
Practice Address - Street 1:509 MCCURDY AVE N UNIT 1
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-4476
Practice Address - Country:US
Practice Address - Phone:256-638-2627
Practice Address - Fax:256-638-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist