Provider Demographics
NPI:1033645056
Name:BLACKWELL, AMANDA JULIETTE (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JULIETTE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 HIGHLAND SQUARE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2280
Mailing Address - Country:US
Mailing Address - Phone:678-464-1516
Mailing Address - Fax:
Practice Address - Street 1:2531 BRIARCLIFF RD NE
Practice Address - Street 2:SUITE 121
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:770-892-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist