Healthcare Provider Details

I. General information

NPI: 1487983458
Provider Name (Legal Business Name): AMANDA G ARNETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 SAINT JOHNS AVE SUITE A
PALATKA FL
32177-6860
US

IV. Provider business mailing address

360 OAK RIDGE TRL
SAINT AUGUSTINE FL
32092-2792
US

V. Phone/Fax

Practice location:
  • Phone: 386-312-0022
  • Fax:
Mailing address:
  • Phone: 904-522-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 21947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: