Provider Demographics
NPI:1265588099
Name:OSBORNE, AMANDA LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5451 SPRING RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3311
Mailing Address - Country:US
Mailing Address - Phone:904-288-4452
Mailing Address - Fax:
Practice Address - Street 1:550 WELLS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2969
Practice Address - Country:US
Practice Address - Phone:904-278-7890
Practice Address - Fax:904-278-7762
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-18559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist