Provider Demographics
NPI:1265065577
Name:PINTER, AMANDA (MS, LAT, SMTC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PINTER
Suffix:
Gender:F
Credentials:MS, LAT, SMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 ASH DR
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-5052
Mailing Address - Country:US
Mailing Address - Phone:385-205-9902
Mailing Address - Fax:
Practice Address - Street 1:8591 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5470
Practice Address - Country:US
Practice Address - Phone:385-205-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT85232255A2300X
AR99417390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty