Provider Demographics
NPI:1588218804
Name:MCMURTRIE, AMANDA GAIL
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:MCMURTRIE
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 1:13220 USF LAUREL DRIVE, MDF 5TH FLOOR
Mailing Address - Street 2:MAIL CODE: MDC106
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13220 USF LAUREL DRIVE, MDF 5TH FLOOR
Practice Address - Street 2:MAIL CODE: MDC106
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:763-233-2376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer