Basic Information
| Provider Information | |||||||||
| NPI: | 1144343088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUM | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ROXANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURNS | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | ROXANNE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 309 RED HILL RD | ||||||||
| Address2: | |||||||||
| City: | PICKENS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296719188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648788127 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 536 OLD HOWELL RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296151969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8775083237 | ||||||||
| FaxNumber: | 8642443093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1854 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.