MEDICARE: AMANDA L KEYS PTA

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	29907	FL
2	225200000X	Physical Therapy Assistant		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952928947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA L KEYS PTA

Provider Business Mailing Address
First Line	:	3149 48TH AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-4344
Country	:	US
Telephone Number	:	727-288-5406
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 31ST ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-4605
Country	:	US
Telephone Number	:	727-867-6955
Fax Number	:

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

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	07/02/2020

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Directions to “ AMANDA L KEYS PTA” Practice Location

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