Provider Demographics
NPI:1134763162
Name:ENZBIGILIS, AMANDA (DPT, PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ENZBIGILIS
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:COURTNEY
Other - Last Name:JUREWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:5251 W US HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735
Practice Address - Country:US
Practice Address - Phone:630-390-6255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-02
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1314088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist