Provider Demographics
NPI:1578947495
Name:ANDERSON, AMANDA CHRISTINE (PT, DPT, MS, OCS)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 SWISS AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6676
Mailing Address - Country:US
Mailing Address - Phone:716-338-3734
Mailing Address - Fax:
Practice Address - Street 1:4101 BRYAN ST # 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6724
Practice Address - Country:US
Practice Address - Phone:972-914-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12694922081S0010X, 225100000X
DEJ1-0003351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE433122ZBSXMedicare PIN
DEG00716Medicare PIN