Organization
AMANDA G STEPHENSON
Active
Other names
The Massage Suite
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA G STEPHENSON L.M.T (MASSAGE THERAPIST)
(304) 431-3535
Entity
Organization
Contact information
Practice address
463D OLD BLUEFIELD RD, PRINCETON, WV 24740-8927
(304) 431-3535
Mailing address
463D OLD BLUEFIELD RD, PRINCETON, WV 24740-8927
(304) 431-3535
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20102705
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20102705
STATE LICENSE NUMBER
WV
Enumeration date
07/12/2010
Last updated
07/12/2010
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