Provider Demographics
NPI:1487983458
Name:ARNETT, AMANDA G (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:G
Last Name:ARNETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 OAK RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2792
Mailing Address - Country:US
Mailing Address - Phone:904-522-0449
Mailing Address - Fax:
Practice Address - Street 1:6050 SAINT JOHNS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6860
Practice Address - Country:US
Practice Address - Phone:386-312-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21947225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant