Provider Demographics
NPI:1609768860
Name:CRENSHAW, AMANDA DAWN (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:CRENSHAW
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 1:6138 E HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-7421
Mailing Address - Country:US
Mailing Address - Phone:850-792-7910
Mailing Address - Fax:866-335-0534
Practice Address - Street 1:6138 E HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-7421
Practice Address - Country:US
Practice Address - Phone:850-792-7910
Practice Address - Fax:866-335-0534
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist