Provider Demographics
NPI:1477985901
Name:PRINCE, AMANDA E (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-1432
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:STE 200
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-896-6800
Practice Address - Fax:615-895-8890
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446631Medicare PIN