Provider Demographics
NPI:1023870250
Name:RILEY, AMANDA PROCTOR (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PROCTOR
Last Name:RILEY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 CLAUDETTE CT
Mailing Address - Street 2:
Mailing Address - City:WAVERLY HALL
Mailing Address - State:GA
Mailing Address - Zip Code:31831-2478
Mailing Address - Country:US
Mailing Address - Phone:706-718-2332
Mailing Address - Fax:
Practice Address - Street 1:6516 KITTEN LAKE DR STE E7
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:GA
Practice Address - Zip Code:31820-3840
Practice Address - Country:US
Practice Address - Phone:706-221-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist