Provider Demographics
NPI:1477041259
Name:JUNG, AMANDA P (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:P
Last Name:JUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6930 HARRIS PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4272
Mailing Address - Country:US
Mailing Address - Phone:817-885-0668
Mailing Address - Fax:817-887-5875
Practice Address - Street 1:6930 HARRIS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4272
Practice Address - Country:US
Practice Address - Phone:817-885-0668
Practice Address - Fax:817-887-5875
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22842225100000X
TX1312892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist