Provider Demographics
NPI:1376964130
Name:HARTER, AMANDA (PT, DPT, OCS, COMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARTER
Suffix:
Gender:F
Credentials:PT, DPT, OCS, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19931 W KELLOGG DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8864
Mailing Address - Country:US
Mailing Address - Phone:316-550-6132
Mailing Address - Fax:316-640-6215
Practice Address - Street 1:19931 W KELLOGG DR UNIT A
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8864
Practice Address - Country:US
Practice Address - Phone:316-550-6132
Practice Address - Fax:316-640-6215
Is Sole Proprietor?:No
Enumeration Date:2013-12-21
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023195225100000X
OR60079225100000X
CA40223225100000X
KS11-04290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist