Physician Compare National (NPI:1285633982)

HEALTHCARE PROVIDER: AMANDA KELLY SOUTHWOOD MPT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1285633982
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628018520
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190507001107
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SOUTHWOOD
	Individual professional last name
Provider First Name	AMANDA
	Individual professional first name
Provider Middle Name	KELLY
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	PT
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	NEXT PT GROUP FLORIDA, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3173865607
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	31
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	12350 SAN JOSE BLVD
	Group Practice or individual's line 1 address
City	JACKSONVILLE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	322232800
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8503804657
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y