Provider Demographics
NPI:1356356091
Name:SOMERS, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SOMERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 W WADE HAMPTON BLVD STE F
Mailing Address - Street 2:PMB 207
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1200
Practice Address - Country:US
Practice Address - Phone:864-801-8706
Practice Address - Fax:864-848-7203
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7796338OtherAETNA PROVIDER NUMBER
SCTH0748Medicaid
SCB6153OtherMEDCOST PROVIDER NUMBER
SC354105600OtherUS DEPT. OF LABOR
SC943423122OtherINSURANCE PROVIDER NUMBER