Provider Demographics
NPI:1366570012
Name:WHITMAN, AMANDA MICHELLE (DPT, MSPT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:DPT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:STE 111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-418-7350
Mailing Address - Fax:813-265-2504
Practice Address - Street 1:2700 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6386
Practice Address - Country:US
Practice Address - Phone:813-805-8108
Practice Address - Fax:813-374-2301
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106773Medicare ID - Type Unspecified
FL38-2617193Medicare UPIN