Provider Demographics
NPI:1396939344
Name:BRASHEAR, AMANDA MONTELL (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MONTELL
Last Name:BRASHEAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1164
Mailing Address - Country:US
Mailing Address - Phone:812-385-5238
Mailing Address - Fax:
Practice Address - Street 1:1020 W VINE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1164
Practice Address - Country:US
Practice Address - Phone:812-385-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003584A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1871531459Medicare UPIN