Provider Demographics
NPI:1265682728
Name:STREET, AMANDA WALLACE (CPO)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:WALLACE
Last Name:STREET
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4608
Mailing Address - Country:US
Mailing Address - Phone:828-254-3392
Mailing Address - Fax:828-254-4380
Practice Address - Street 1:1 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801
Practice Address - Country:US
Practice Address - Phone:828-254-3392
Practice Address - Fax:828-254-4380
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist