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General NPI Number Information
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NPI Number | 1508905795
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Entity Type | Individual
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Provider Name | MS. AMANDA COLETTE DIERKING
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1224 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4802
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Country | US
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Telephone | 931-540-4302
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Fax |
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Provider Business Mailing Address
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Address Line | 11303 CROWNE BROOK CIR
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City | FRANKLIN
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State | TN
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Zip | 37067-1660
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Country | US
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Telephone | 615-390-7754
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA0000003969
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License Number State | TN
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