Provider Demographics
NPI:1114242740
Name:HARRIS, AMANDA MCCARTY (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MCCARTY
Last Name:HARRIS
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 1:2801 S OLIVE ST
Mailing Address - Street 2:SUITE 9D
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5433
Mailing Address - Country:US
Mailing Address - Phone:870-541-0003
Mailing Address - Fax:870-541-0008
Practice Address - Street 1:2801 S OLIVE ST
Practice Address - Street 2:SUITE 9D
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5433
Practice Address - Country:US
Practice Address - Phone:870-541-0003
Practice Address - Fax:870-541-0008
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist