Provider Demographics
NPI:1760747315
Name:HAWS, AMANDA N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:N
Last Name:HAWS
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 1:11003 MONTGOMERY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2306
Mailing Address - Country:US
Mailing Address - Phone:513-469-1444
Mailing Address - Fax:513-247-9484
Practice Address - Street 1:11003 MONTGOMERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2306
Practice Address - Country:US
Practice Address - Phone:513-469-1444
Practice Address - Fax:513-247-9484
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-013788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214940Medicaid
OH0214940Medicaid