Provider Demographics
NPI:1093222382
Name:HARPER-BROWN, AMANDA (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARPER-BROWN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 CACTUS ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6126
Mailing Address - Country:US
Mailing Address - Phone:386-341-5272
Mailing Address - Fax:
Practice Address - Street 1:733 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4225
Practice Address - Country:US
Practice Address - Phone:386-756-0077
Practice Address - Fax:386-756-0077
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24091225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant