Provider Demographics
NPI:1518759968
Name:LANTZ, AMANDA (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LANTZ
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 1:4224 WINDSLOW DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8292
Mailing Address - Country:US
Mailing Address - Phone:724-816-5103
Mailing Address - Fax:
Practice Address - Street 1:350 AUSTIN GRAYBILL RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9251
Practice Address - Country:US
Practice Address - Phone:803-278-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6855225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant