Provider Demographics
NPI:1396299046
Name:GRIFFIN, AMANDA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-4736
Mailing Address - Country:US
Mailing Address - Phone:207-215-4511
Mailing Address - Fax:
Practice Address - Street 1:380 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4736
Practice Address - Country:US
Practice Address - Phone:207-215-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16441171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor