Provider Demographics
NPI:1700394921
Name:DANIEL, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DANIEL
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 1:8375 FREEDOM CROSSING RD UNIT J
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1536
Mailing Address - Country:US
Mailing Address - Phone:859-806-2502
Mailing Address - Fax:
Practice Address - Street 1:8375 FREEDOM CROSSING RD UNIT J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235
Practice Address - Country:US
Practice Address - Phone:859-806-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2022-10-25
Deactivation Date:2022-09-01
Deactivation Code:
Reactivation Date:2022-09-27
Provider Licenses
StateLicense IDTaxonomies
OHAT0058922255A2300X
OHPT019709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer