Provider Demographics
NPI:1780901744
Name:GIDDENS, AMANDA (ATC, PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GIDDENS
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 EASTWEST PKWY STE 11-12
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6336
Mailing Address - Country:US
Mailing Address - Phone:904-215-3958
Mailing Address - Fax:
Practice Address - Street 1:1835 EASTWEST PKWY STE 11-12
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6336
Practice Address - Country:US
Practice Address - Phone:904-215-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist