Provider Demographics
NPI:1609880228
Name:PHILLIPS, AMANDA L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE S
Mailing Address - Street 2:PT/OT PARK PLACE 3RD FLOOR
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-939-6289
Mailing Address - Fax:
Practice Address - Street 1:1600 5TH AVE S
Practice Address - Street 2:PT/OT PARK PLACE 3RD FLOOR
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1700
Practice Address - Country:US
Practice Address - Phone:205-939-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH47392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-34906OtherBCBS