Provider Demographics
NPI:1457928814
Name:RENFRO, AMANDA FLORY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:FLORY
Last Name:RENFRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WESTGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3443
Mailing Address - Country:US
Mailing Address - Phone:817-296-5466
Mailing Address - Fax:
Practice Address - Street 1:4901 BRYANT IRVIN RD N STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7673
Practice Address - Country:US
Practice Address - Phone:817-433-9742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1345854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist