Provider Demographics
NPI:1124399639
Name:SPENCER, AMANDA HOLLIDAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:HOLLIDAY
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SPENCER MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-2542
Mailing Address - Country:US
Mailing Address - Phone:336-301-6150
Mailing Address - Fax:
Practice Address - Street 1:621 SPENCER MEADOW RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-2542
Practice Address - Country:US
Practice Address - Phone:336-301-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20032251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics