Amanda Dehart, LMT
Individual provider Active NPI Massage Therapist · Palmer, AK
NPI 1770177271 · NPPES record last updated Feb 24, 2021
Key facts
- NPI
- 1770177271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 169287 (AK)
- Practice address
- 108 E Arctic Ave
Palmer, AK 99645-6254 - Phone
- (907) 745-4357
- NPI assigned
- Feb 24, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 169287 | AK | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bionic Chiropractic | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | AK | ||
| Massage Therapist | 225700000X | 169287 | AK | Yes |
Addresses
Primary practice location
108 E Arctic Ave
Palmer, AK 99645-6254
Mailing address
108 E Arctic Ave
Palmer, AK 99645-6254
Phone (907) 745-4357
Other providers in Palmer, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.