Provider Demographics
NPI:1255903316
Name:SHARP, AMANDA JANE (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:SHARP
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 OAKDALE RD SE APT 134
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7160
Mailing Address - Country:US
Mailing Address - Phone:847-894-4557
Mailing Address - Fax:
Practice Address - Street 1:EMORY SPORTS MEDICINE COMPLEX
Practice Address - Street 2:1968 HAWKS LANE
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-778-6330
Practice Address - Fax:404-778-6370
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0153242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic