Provider Demographics
NPI:1093121246
Name:DOSS, AMANDA JANE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:DOSS
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 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:336-718-6700
Mailing Address - Fax:336-718-6798
Practice Address - Street 1:1903 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3916
Practice Address - Country:US
Practice Address - Phone:336-718-6700
Practice Address - Fax:336-718-6798
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NCP8340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist