Provider Demographics
NPI:1164617726
Name:PARTON, AMANDA JANE (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:PARTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JANE
Other - Last Name:TRAGESSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1220 LAGUNA ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2330
Mailing Address - Country:US
Mailing Address - Phone:765-454-5340
Mailing Address - Fax:765-454-5347
Practice Address - Street 1:1220 LAGUNA ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-2330
Practice Address - Country:US
Practice Address - Phone:765-454-5340
Practice Address - Fax:765-454-5347
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005069A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist