Provider Demographics
NPI:1124420054
Name:MARTINEZ, AMANDA (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MARTINEZ
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 1:900 EMERALD FOREST BLVD
Mailing Address - Street 2:APT 8102
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5961
Mailing Address - Country:US
Mailing Address - Phone:985-773-4405
Mailing Address - Fax:
Practice Address - Street 1:433 METAIRIE RD
Practice Address - Street 2:106
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4333
Practice Address - Country:US
Practice Address - Phone:504-835-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist