Basic Information
| Provider Information | |||||||||
| NPI: | 1427191980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEFFERSON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 MAHLON MOORE RD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371742134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314895886 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5228 MAIN ST | ||||||||
| Address2: | SUITE A2 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371747402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314860599 | ||||||||
| FaxNumber: | 9314863962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0000002969 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.