Provider Demographics
NPI:1386405561
Name:TROTMAN, AMANDA (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TROTMAN
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 1:11121 SILVER DANCER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2354
Mailing Address - Country:US
Mailing Address - Phone:727-421-7663
Mailing Address - Fax:
Practice Address - Street 1:11121 SILVER DANCER DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2354
Practice Address - Country:US
Practice Address - Phone:727-421-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100440225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist