Provider Demographics
NPI:1790989697
Name:TEMPLE, AMANDA JO (MPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:820 SCENIC HWY STE B
Practice Address - Street 2:MOUNTAIN CENTER BUILDING
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37350-1474
Practice Address - Country:US
Practice Address - Phone:423-825-1393
Practice Address - Fax:423-825-6147
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT7833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN03650060Medicaid
TN3650028Medicare PIN
TN3650060Medicare ID - Type UnspecifiedGROUP #