Individual
AMANDA LEIGH DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2180 A1A S, SUITE 100, ST AUGUSTINE, FL 32080-6591
(904) 806-6846
(904) 471-6236
Mailing address
505 WHISPERING CIR, APT 13, ST AUGUSTINE, FL 32084-0842
(904) 806-6849
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 41898
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC3936
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/07/2007
Last updated
07/08/2007
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