Individual
AMANDA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2411 3RD AVE, HUNTINGTON, WV 25702
(304) 914-8054
Mailing address
PO BOX 4100, BARBOURSVILLE, WV 25504-4100
(304) 914-8054
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2016-3449
WV
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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