Provider Demographics
NPI:1659651503
Name:THOMAS, AMANDA R (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4546
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4546
Mailing Address - Country:US
Mailing Address - Phone:336-629-6397
Mailing Address - Fax:336-629-6939
Practice Address - Street 1:105 S BRADY ST
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-9538
Practice Address - Country:US
Practice Address - Phone:336-824-8855
Practice Address - Fax:336-824-8955
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10940OtherPT LICENSE