Provider Demographics
NPI:1740781434
Name:MATTINGLY, AMANDA (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 WESTWIND TRL
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1827
Mailing Address - Country:US
Mailing Address - Phone:502-741-7810
Mailing Address - Fax:
Practice Address - Street 1:704 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2025
Practice Address - Country:US
Practice Address - Phone:502-331-5478
Practice Address - Fax:502-385-0234
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant