Provider Demographics
NPI:1578939054
Name:HOLLAND, AMANDA DIANE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIANE
Last Name:HOLLAND
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 1:1553 JANMAR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5606
Mailing Address - Country:US
Mailing Address - Phone:678-987-0250
Mailing Address - Fax:678-987-0217
Practice Address - Street 1:1553 JANMAR RD
Practice Address - Street 2:SUITE B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5606
Practice Address - Country:US
Practice Address - Phone:678-987-0250
Practice Address - Fax:678-987-0217
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist