Provider Demographics
NPI:1013395631
Name:MARTIN, AMANDA E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18806
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28814-0806
Mailing Address - Country:US
Mailing Address - Phone:828-348-1780
Mailing Address - Fax:877-922-4820
Practice Address - Street 1:640 MERRIMON AVE STE 107
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3456
Practice Address - Country:US
Practice Address - Phone:828-348-1780
Practice Address - Fax:877-922-4820
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT13861225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports