Provider Demographics
NPI:1326744293
Name:GRIFFITH, AMANDA SUE (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 DELL TRL
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-5511
Mailing Address - Country:US
Mailing Address - Phone:423-949-4651
Mailing Address - Fax:
Practice Address - Street 1:6890 OLD DUNLAP RD
Practice Address - Street 2:
Practice Address - City:WHITWELL
Practice Address - State:TN
Practice Address - Zip Code:37397-6366
Practice Address - Country:US
Practice Address - Phone:423-762-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant