Provider Demographics
NPI:1235609553
Name:ROBINETT, AMANDA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROBINETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 MAYROCK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0056
Mailing Address - Country:US
Mailing Address - Phone:419-822-6953
Mailing Address - Fax:
Practice Address - Street 1:4011 W JEFFERSON BLVD STE 175
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6848
Practice Address - Country:US
Practice Address - Phone:260-900-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012015A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist