Provider Demographics
NPI:1093964454
Name:CARCONE, AMANDA (MPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CARCONE
Suffix:
Gender:F
Credentials:MPT
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 670207
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0121
Mailing Address - Country:US
Mailing Address - Phone:770-517-2480
Mailing Address - Fax:770-592-9431
Practice Address - Street 1:2465 CANOPY GLN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1541
Practice Address - Country:US
Practice Address - Phone:770-517-2480
Practice Address - Fax:770-592-9431
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9300225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics