Provider Demographics
NPI:1902618846
Name:SAPP, AMANDA CAROLYN (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CAROLYN
Last Name:SAPP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CAROLYN
Other - Last Name:SAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMANDA DESMOND
Mailing Address - Street 1:9206 E IRONBARK ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5356
Mailing Address - Country:US
Mailing Address - Phone:520-867-1660
Mailing Address - Fax:
Practice Address - Street 1:850 N KOLB RD STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1333
Practice Address - Country:US
Practice Address - Phone:520-867-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT30444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist