Provider Demographics
NPI:1285450577
Name:MORRISON, AMANDA MEGAN (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MEGAN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MEGAN
Other - Last Name:BRANDENBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:7012 W ALEXANDRIA RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-9280
Mailing Address - Country:US
Mailing Address - Phone:513-907-5547
Mailing Address - Fax:
Practice Address - Street 1:585 OH-741
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-932-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08698225200000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant