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General NPI Number Information
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NPI Number | 1124399639
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Entity Type | Individual
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Provider Name | AMANDA HOLLIDAY SPENCER PT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 01/16/2012
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Provider Practice Location Address
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Address Line | 621 SPENCER MEADOW RD
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City | ASHEBORO
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State | NC
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Zip | 27205-2542
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Country | US
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Telephone | 336-301-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 621 SPENCER MEADOW RD
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City | ASHEBORO
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State | NC
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Zip | 27205-2542
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Country | US
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Telephone | 336-301-6150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2003
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License Number State | NC
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