Provider Demographics
NPI:1427382720
Name:HAYES FUGATE, AMANDA GWEN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GWEN
Last Name:HAYES FUGATE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:GWEN
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:110 MOUNT CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806
Mailing Address - Country:US
Mailing Address - Phone:828-582-9718
Mailing Address - Fax:828-684-3612
Practice Address - Street 1:110 MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806
Practice Address - Country:US
Practice Address - Phone:828-582-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123522251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic