Organization
AMANDA'S MINI DAY SPA
Active
Other names
Amanda Mitchell
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA MITCHELL LMT (MASSAGE THERAPIST)
(618) 531-7325
Entity
Organization
Contact information
Practice address
510 E CHAIN OF ROCKS RD, GRANITE CITY, IL 62040-2803
(314) 467-0766
Mailing address
510 E CHAIN OF ROCKS RD, GRANITE CITY, IL 62040-2803
(314) 467-0766
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
001010642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001010642
MASSAGE THERAPIST
IL
Enumeration date
01/12/2015
Last updated
01/12/2015
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