Provider Demographics
NPI:1053935197
Name:MORGAN, AMANDA ANN (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:MORGAN
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 1:2357 NEW HOLT RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7404
Mailing Address - Country:US
Mailing Address - Phone:270-554-0090
Mailing Address - Fax:
Practice Address - Street 1:2357 NEW HOLT RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7404
Practice Address - Country:US
Practice Address - Phone:270-554-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY106414OtherKY MASSAGE BOARD
KY179788OtherAMTA