Provider Demographics
NPI:1548450554
Name:DEARMAN, AMANDA CANIZARO (PT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:CANIZARO
Last Name:DEARMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:CANIZARO
Other - Last Name:DEARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:175 NUTMEG RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-2203
Mailing Address - Country:US
Mailing Address - Phone:601-672-8039
Mailing Address - Fax:
Practice Address - Street 1:104 BURNEY DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-6621
Practice Address - Country:US
Practice Address - Phone:601-987-8200
Practice Address - Fax:601-987-8211
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist