Provider Demographics
NPI:1265543722
Name:BARKER, AMANDA L (PT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:BARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N PYRITE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6018
Mailing Address - Country:US
Mailing Address - Phone:479-445-6800
Mailing Address - Fax:479-445-6816
Practice Address - Street 1:5230 WILLOW CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0876
Practice Address - Country:US
Practice Address - Phone:479-445-6800
Practice Address - Fax:479-445-6816
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT20392251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132986721Medicaid
AR5T725OtherBCBS