Healthcare Provider Details

I. General information

NPI: 1457742462
Provider Name (Legal Business Name): AMANDA MARIE HOUCK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BROADWATER DPT

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11560 CHAPMAN HWY STE 1
SEYMOUR TN
37865-5387
US

IV. Provider business mailing address

1103 VILLAGE DR
SEVIERVILLE TN
37862-5029
US

V. Phone/Fax

Practice location:
  • Phone: 865-579-3322
  • Fax: 865-579-0820
Mailing address:
  • Phone: 865-908-7041
  • Fax: 865-908-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10316
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: