Provider Demographics
NPI:1164767414
Name:BRANT, AMANDA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:BRANT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MILLS PL
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-1430
Mailing Address - Country:US
Mailing Address - Phone:937-687-1311
Mailing Address - Fax:937-687-3991
Practice Address - Street 1:101 MILLS PL
Practice Address - Street 2:
Practice Address - City:NEW LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45345-1430
Practice Address - Country:US
Practice Address - Phone:937-687-1311
Practice Address - Fax:937-687-3991
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.012218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist