Basic Information
| Provider Information | |||||||||
| NPI: | 1184051484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEATH | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ALBERTSON | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751274 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196204700 | ||||||||
| FaxNumber: | 9196204921 | ||||||||
| Practice Location | |||||||||
| Address1: | 2675 CHURTON STREET | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | HILLSBOROUGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272782506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196842445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2013 | ||||||||
| LastUpdateDate: | 10/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14223 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.