Provider Demographics
NPI:1083200091
Name:LOVING, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LOVING
Suffix:
Gender:F
Credentials:
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 216
Mailing Address - Street 2:
Mailing Address - City:GRAYS KNOB
Mailing Address - State:KY
Mailing Address - Zip Code:40829-0216
Mailing Address - Country:US
Mailing Address - Phone:606-505-8566
Mailing Address - Fax:
Practice Address - Street 1:5411 S US HIGHWAY 421
Practice Address - Street 2:
Practice Address - City:GRAYS KNOB
Practice Address - State:KY
Practice Address - Zip Code:40829-8315
Practice Address - Country:US
Practice Address - Phone:606-505-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer