Provider Demographics
NPI:1093547978
Name:BOWER, AMANDA (MT-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5042 42ND ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4720
Mailing Address - Country:US
Mailing Address - Phone:727-871-2784
Mailing Address - Fax:727-537-9389
Practice Address - Street 1:5042 42ND ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4720
Practice Address - Country:US
Practice Address - Phone:727-871-2784
Practice Address - Fax:727-537-9389
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18660225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist