Provider Demographics
NPI:1043494628
Name:CARTER, AMANDA JO (LMT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JO
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:IWANCIW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1038 GOLF VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-5127
Mailing Address - Country:US
Mailing Address - Phone:615-423-9568
Mailing Address - Fax:
Practice Address - Street 1:1038 GOLF VIEW WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-5127
Practice Address - Country:US
Practice Address - Phone:615-423-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist