Provider Demographics
NPI:1538723630
Name:FLOYD, AMANDA JANE (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:FLOYD
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 1:12015 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9759
Mailing Address - Country:US
Mailing Address - Phone:419-308-5206
Mailing Address - Fax:
Practice Address - Street 1:4000 FOXHOUND DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1014
Practice Address - Country:US
Practice Address - Phone:215-402-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty