Provider Demographics
NPI:1538600622
Name:TORRANCE, AMANDA (LMT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:TORRANCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N LIMA APT 3
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1473
Mailing Address - Country:US
Mailing Address - Phone:217-413-6251
Mailing Address - Fax:
Practice Address - Street 1:901 N LIMA APT 3
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1473
Practice Address - Country:US
Practice Address - Phone:217-413-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist