Provider Demographics
NPI:1841677283
Name:MORRISON, AMANDA FAYE (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAYE
Last Name:MORRISON
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 1:3665 BRADEN RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TN
Mailing Address - Zip Code:38049-7463
Mailing Address - Country:US
Mailing Address - Phone:901-212-8353
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER, SUITE 203
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:888-317-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09150225200000X
MS5190225200000X
TN5258225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant