MEDICARE: AMANDA LEE PTA, LMT

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	28701	FL

General Provider Information

NPI Number	:	1134688310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEE PTA, LMT

Provider Business Mailing Address
First Line	:	9370 SW 185TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33157-7036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 HOLLYWOOD BLVD STE 200
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6926
Country	:	US
Telephone Number	:	954-986-0339
Fax Number	:

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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