Healthcare Provider Details

I. General information

NPI: 1265588099
Provider Name (Legal Business Name): AMANDA LYNN OSBORNE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LYNN CRANE PT

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WELLS RD SUITE 4
ORANGE PARK FL
32073-2969
US

IV. Provider business mailing address

5451 SPRING RIDGE CT
JACKSONVILLE FL
32258-3311
US

V. Phone/Fax

Practice location:
  • Phone: 904-278-7890
  • Fax: 904-278-7762
Mailing address:
  • Phone: 904-288-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-18559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: