Provider Demographics
NPI:1528006400
Name:HALL, AMANDA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3606
Mailing Address - Country:US
Mailing Address - Phone:207-324-6789
Mailing Address - Fax:207-324-6789
Practice Address - Street 1:1068 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3606
Practice Address - Country:US
Practice Address - Phone:207-324-6789
Practice Address - Fax:207-324-6789
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2837225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant