Provider Demographics
NPI:1467700278
Name:JAMESON, AMANDA BROOK (PT DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOK
Last Name:JAMESON
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 PRAIRIE TIMBER RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7688
Mailing Address - Country:US
Mailing Address - Phone:817-713-4732
Mailing Address - Fax:
Practice Address - Street 1:1901 N HWY 360 # 320
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1412
Practice Address - Country:US
Practice Address - Phone:972-239-3633
Practice Address - Fax:972-239-3636
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1221749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist