Healthcare Provider Details

I. General information

NPI: 1265988547
Provider Name (Legal Business Name): AMANDA WINSLOW DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SABLE WOOD DR
GREENBRIER AR
72058-8902
US

IV. Provider business mailing address

9 SABLEWOOD DRIVE
GREENBRIER AR
72058
US

V. Phone/Fax

Practice location:
  • Phone: 479-692-3843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2787
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: