Provider Demographics
NPI:1306132584
Name:DUPAS, AMANDA ANASTASIA (LMT, CMMT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ANASTASIA
Last Name:DUPAS
Suffix:
Gender:F
Credentials:LMT, CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 CITIZENS BANK DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3423
Mailing Address - Country:US
Mailing Address - Phone:318-780-6560
Mailing Address - Fax:
Practice Address - Street 1:1914 CITIZENS BANK DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3423
Practice Address - Country:US
Practice Address - Phone:318-780-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist