Healthcare Provider Details

I. General information

NPI: 1881944841
Provider Name (Legal Business Name): AMANDA HARDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TAMIAMI TRL S 210
VENICE FL
34285-2614
US

IV. Provider business mailing address

1600 FAWNWOOD CIR
SARASOTA FL
34232-5948
US

V. Phone/Fax

Practice location:
  • Phone: 941-483-3400
  • Fax:
Mailing address:
  • Phone: 260-241-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 27523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: