MEDICARE: AMANDA STRACK

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
1	225200000X	Physical Therapy Assistant	2062840	TX

General Provider Information

NPI Number	:	1104186998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA STRACK

Provider Business Mailing Address
First Line	:	1799 FM 528 RD
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4710
Country	:	US
Telephone Number	:	832-326-1161
Fax Number	:

Provider Business Practice Location Address
First Line	:	13100 NORTHWEST FWY
Second Line	:	SUITE 360
City	:	HOUSTON
State	:	TX
Zip	:	77040-6310
Country	:	US
Telephone Number	:	713-877-8447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	05/25/2012

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Directions to “ AMANDA STRACK ” Practice Location

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