MEDICARE: DR. AMANDA RENE PRATT PT, DPT

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	225100000X	Physical Therapist	PT24117	FL

General Provider Information

NPI Number	:	1629388962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA RENE PRATT PT, DPT

Provider Business Mailing Address
First Line	:	6639 SOUTHPOINT PKWY
Second Line	:	STE. 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6639 SOUTHPOINT PKWY
Second Line	:	STE. 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8041
Country	:	US
Telephone Number	:	904-296-4140
Fax Number	:	904-279-0963

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

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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