Provider Demographics
NPI:1518374925
Name:ARBUCKLE, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ARBUCKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FM 2181
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7636
Mailing Address - Country:US
Mailing Address - Phone:940-498-4004
Mailing Address - Fax:940-498-4008
Practice Address - Street 1:3600 FM 2181
Practice Address - Street 2:SUITE 400
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7636
Practice Address - Country:US
Practice Address - Phone:940-498-4004
Practice Address - Fax:940-498-4008
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3115140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist