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General NPI Number Information
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NPI Number | 1447333257
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Entity Type | Individual
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Provider Name | AMANDA JO FELLERS PT
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 401 E WASHINGTON AVE SUITE 200
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City | NAVASOTA
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State | TX
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Zip | 77868-3047
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Country | US
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Telephone | 936-870-3475
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Fax | 936-870-3476
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Provider Business Mailing Address
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Address Line | PO BOX 11287
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City | COLLEGE STATION
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State | TX
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Zip | 77842-1287
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Country | US
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Telephone | 936-870-3475
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Fax | 936-870-3476
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1165307
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License Number State | TX
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