Provider Demographics
NPI:1215737754
Name:WINTERS, AMANDA R (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:WINTERS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12410 COASTAL MARSH DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2768
Mailing Address - Country:US
Mailing Address - Phone:443-754-4309
Mailing Address - Fax:
Practice Address - Street 1:9935 STEPHEN DECATUR HWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9579
Practice Address - Country:US
Practice Address - Phone:443-754-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty