Individual
AMANDA ELLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2322 BUTANO DR STE 214, SACRAMENTO, CA 95825-0657
(916) 715-5755
Mailing address
2322 BUTANO DR STE 214, SACRAMENTO, CA 95825-0657
(191) 671-5575
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
25772
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25772
CAMTC
CA
Enumeration date
11/24/2018
Last updated
11/24/2018
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