Provider Demographics
NPI:1184908006
Name:COLE, AMANDA (LMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 SYDNEY CT
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5414
Mailing Address - Country:US
Mailing Address - Phone:321-229-2518
Mailing Address - Fax:
Practice Address - Street 1:100 BURNSED PL
Practice Address - Street 2:SUITE 1020
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6695
Practice Address - Country:US
Practice Address - Phone:407-971-3840
Practice Address - Fax:407-333-2281
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63799171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor