MEDICARE: AMANDA STRADER PT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11322	OTHER	NC	PHYSICAL THERAPY
2	7428	OTHER	TN	LICENSE#

General Provider Information

NPI Number	:	1003926965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA STRADER PT, ATC

Provider Business Mailing Address
First Line	:	640 S VAN BUREN RD UNIT B
Second Line	:
City	:	EDEN
State	:	NC
Zip	:	27288-5365
Country	:	US
Telephone Number	:	336-623-0975
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 OAK BRANCH DR STE E
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2392
Country	:	US
Telephone Number	:	336-294-0910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/05/2021

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