Provider Demographics
NPI:1740353192
Name:EDRINGTON, AMANDA CANTRELL (PT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CANTRELL
Last Name:EDRINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 FOSSIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7890
Mailing Address - Country:US
Mailing Address - Phone:770-888-0373
Mailing Address - Fax:770-888-9705
Practice Address - Street 1:2255 FOSSIL CREEK DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7890
Practice Address - Country:US
Practice Address - Phone:770-888-0373
Practice Address - Fax:770-888-9705
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001683225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist