Provider Demographics
NPI:1942506639
Name:NIX, AMANDA (PT, ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NIX
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, ATC
Mailing Address - Street 1:660 MERRIMON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3567
Mailing Address - Country:US
Mailing Address - Phone:828-348-1780
Mailing Address - Fax:
Practice Address - Street 1:660 MERRIMON AVE STE C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3567
Practice Address - Country:US
Practice Address - Phone:828-348-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT12938208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1679780092OtherFACILITY
GAGRP8088Medicare PIN