Provider Demographics
NPI:1700197787
Name:ALLING, AMANDA TOLBERT (PT, DPT, PRPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TOLBERT
Last Name:ALLING
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, PRPC
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:15757 WC MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7327
Practice Address - Country:US
Practice Address - Phone:804-858-0220
Practice Address - Fax:804-419-0127
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA373960OtherBCBS (PHYSICAL THERAPY)
VA9699546OtherAETNA
VA1700197787Medicaid
VAP00853526OtherRAILROAD MEDICARE
VAC05954Medicare PIN
VA1700197787Medicaid