Healthcare Provider Details

I. General information

NPI: 1528462215
Provider Name (Legal Business Name): AMANDA HEDGES FULENWIDER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15420 S HARRELLS FERRY RD STE D
BATON ROUGE LA
70816-2933
US

IV. Provider business mailing address

10101 PARK ROWE AVE STE 200
BATON ROUGE LA
70810-1685
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2200
  • Fax: 833-756-2680
Mailing address:
  • Phone: 225-769-2200
  • Fax: 833-756-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number08793
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: