Provider Demographics
NPI:1326127689
Name:SHIPLEY, AMANDA (PT, DPT, MTC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MTC
Mailing Address - Street 1:2040 TUXEDO AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1820
Mailing Address - Country:US
Mailing Address - Phone:404-769-5544
Mailing Address - Fax:404-393-3739
Practice Address - Street 1:1392 MCLENDON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2030
Practice Address - Country:US
Practice Address - Phone:404-769-5544
Practice Address - Fax:404-393-9578
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008129OtherSTATE LISC NUMBER