Provider Demographics
NPI:1134754781
Name:WORSHAM, AMANDA KAREN (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAREN
Last Name:WORSHAM
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 1:300 GOOD SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5813
Mailing Address - Country:US
Mailing Address - Phone:870-425-2494
Mailing Address - Fax:870-425-4080
Practice Address - Street 1:300 GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-5813
Practice Address - Country:US
Practice Address - Phone:870-425-2494
Practice Address - Fax:870-425-4080
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1714225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty