Healthcare Provider Details

I. General information

NPI: 1790989697
Provider Name (Legal Business Name): AMANDA JO TEMPLE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JO MORRIS PT

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SCENIC HWY STE B MOUNTAIN CENTER BUILDING
LOOKOUT MOUNTAIN TN
37350-1474
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 423-825-1393
  • Fax: 423-825-6147
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7833
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: