Provider Demographics
NPI:1063094837
Name:NEAL, AMANDA S (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:S
Last Name:NEAL
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 1:980 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2151
Mailing Address - Country:US
Mailing Address - Phone:405-550-0898
Mailing Address - Fax:
Practice Address - Street 1:1215 CROSSROADS BLVD STE 214
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3391
Practice Address - Country:US
Practice Address - Phone:405-550-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK180098225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist