Provider Demographics
NPI:1508877655
Name:HUGGARD, AMANDA JOY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOY
Last Name:HUGGARD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2005 MARLTON PIKE E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1279
Mailing Address - Country:US
Mailing Address - Phone:856-874-1166
Mailing Address - Fax:856-874-1188
Practice Address - Street 1:2005 MARLTON PIKE E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1279
Practice Address - Country:US
Practice Address - Phone:856-874-1166
Practice Address - Fax:856-874-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 2251X0800X, 2255A2300X
NJPT40QA010432002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070929Medicare ID - Type Unspecified