Provider Demographics
NPI:1306505052
Name:WARD, AMANDA ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:WARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:YOHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18967 ALFARO LOOP
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-6417
Mailing Address - Country:US
Mailing Address - Phone:239-210-8237
Mailing Address - Fax:
Practice Address - Street 1:18967 ALFARO LOOP
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6417
Practice Address - Country:US
Practice Address - Phone:239-210-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27991225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant