Provider Demographics
NPI:1386915833
Name:EWING, AMANDA N
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:N
Last Name:EWING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12891 DEANS RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBLUFF
Mailing Address - State:MS
Mailing Address - Zip Code:39741-9451
Mailing Address - Country:US
Mailing Address - Phone:662-295-9268
Mailing Address - Fax:
Practice Address - Street 1:1001 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2125
Practice Address - Country:US
Practice Address - Phone:662-323-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4350225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant