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NPI Code Detail

MEDICARE: AMANDA STRADER PT, ATC

MEDICARE: AMANDA STRADER PT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111322OTHERNCPHYSICAL THERAPY
27428OTHERTNLICENSE#

General Provider Information

NPI Number : 1003926965
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA STRADER PT, ATC
Provider Business Mailing Address
First Line : 640 S VAN BUREN RD UNIT B
Second Line :
City : EDEN
State : NC
Zip : 27288-5365
Country : US
Telephone Number : 336-623-0975
Fax Number :
Provider Business Practice Location Address
First Line : 7 OAK BRANCH DR STE E
Second Line :
City : GREENSBORO
State : NC
Zip : 27407-2392
Country : US
Telephone Number : 336-294-0910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 04/05/2021

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