Provider Demographics
NPI:1104227636
Name:NEAL, AMANDA JO (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
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 1:1729 BLUE RUN RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8779
Mailing Address - Country:US
Mailing Address - Phone:740-820-5137
Mailing Address - Fax:
Practice Address - Street 1:1729 BLUE RUN RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8779
Practice Address - Country:US
Practice Address - Phone:740-820-5137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021419172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist