Provider Demographics
NPI:1013314939
Name:EDWARDS, AMANDA (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ADDISON SQ STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5527
Mailing Address - Country:US
Mailing Address - Phone:706-309-0016
Mailing Address - Fax:
Practice Address - Street 1:67 LACEY RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-2912
Practice Address - Country:US
Practice Address - Phone:732-849-1088
Practice Address - Fax:732-849-0080
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01580600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist