Provider Demographics
NPI:1043507544
Name:BLEVINS, AMANDA (DPT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:BLEVINS
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 1:12510 PROSPERITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1615
Mailing Address - Country:US
Mailing Address - Phone:301-680-7130
Mailing Address - Fax:301-680-7132
Practice Address - Street 1:12510 PROSPERITY DR STE 120
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1615
Practice Address - Country:US
Practice Address - Phone:301-680-7130
Practice Address - Fax:301-680-7132
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist