Provider Demographics
NPI:1548652043
Name:WEATHERMAN, AMY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:WEATHERMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TAYLORWOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-3409
Mailing Address - Country:US
Mailing Address - Phone:276-236-3000
Mailing Address - Fax:
Practice Address - Street 1:101 TAYLORWOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3409
Practice Address - Country:US
Practice Address - Phone:276-236-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019012985225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist