Basic Information
| Provider Information | |||||||||
| NPI: | 1467409136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 MEADOWLARK DR | ||||||||
| Address2: | |||||||||
| City: | HARTSELLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356407041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567922324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 927 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564283000 | ||||||||
| FaxNumber: | 2564283003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 09/17/2007 | ||||||||
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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 | 225100000X | PTH4589 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.