Provider Demographics
NPI:1457742462
Name:HOUCK, AMANDA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HOUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BROADWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1103 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5029
Mailing Address - Country:US
Mailing Address - Phone:865-908-7041
Mailing Address - Fax:865-908-7043
Practice Address - Street 1:11560 CHAPMAN HWY STE 1
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5387
Practice Address - Country:US
Practice Address - Phone:865-579-3322
Practice Address - Fax:865-579-0820
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist