Provider Demographics
NPI:1538993860
Name:DOWDY, AMANDA JEAN (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:DOWDY
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 1:37512 MIDLAND TRL E
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:WV
Mailing Address - Zip Code:24925-7096
Mailing Address - Country:US
Mailing Address - Phone:304-520-5829
Mailing Address - Fax:
Practice Address - Street 1:945 WASHINGTON ST W STE 5
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-2580
Practice Address - Country:US
Practice Address - Phone:304-520-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2022-3950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist