Provider Demographics
NPI:1669817342
Name:DAVITT, AMANDA R (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:DAVITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 FOREST HILLS BLVD
Mailing Address - Street 2:205
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-3016
Mailing Address - Country:US
Mailing Address - Phone:479-855-9348
Mailing Address - Fax:479-855-9358
Practice Address - Street 1:1801 FOREST HILLS BLVD
Practice Address - Street 2:205
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3016
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:479-855-9358
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2271225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant