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NPI Code Detail

MEDICARE: MS. AMANDA BRANT MSPT

MEDICARE: MS. AMANDA BRANT MSPT
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 TherapistPT.012218OH

General Provider Information

NPI Number : 1164767414
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA BRANT MSPT
Provider Business Mailing Address
First Line : 101 MILLS PL
Second Line :
City : NEW LEBANON
State : OH
Zip : 45345-1430
Country : US
Telephone Number : 937-687-1311
Fax Number : 937-687-3991
Provider Business Practice Location Address
First Line : 101 MILLS PL
Second Line :
City : NEW LEBANON
State : OH
Zip : 45345-1430
Country : US
Telephone Number : 937-687-1311
Fax Number : 937-687-3991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2012
Last Update Date : 11/27/2012

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