Provider Demographics
NPI:1184804734
Name:RICHARDSON, AMANDA HOPE (PT, DPT)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:HOPE
Last Name:RICHARDSON
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 1:2328 CAMELIA ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-2510
Mailing Address - Country:US
Mailing Address - Phone:803-422-7105
Mailing Address - Fax:
Practice Address - Street 1:2328 CAMELIA ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-2510
Practice Address - Country:US
Practice Address - Phone:803-422-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5627172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker