Provider Demographics
NPI:1366604852
Name:LASSETER, AMANDA (PT, DPT, COMT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:LASSETER
Suffix:
Gender:F
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2506
Mailing Address - Country:US
Mailing Address - Phone:406-219-1090
Mailing Address - Fax:
Practice Address - Street 1:410 N 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2506
Practice Address - Country:US
Practice Address - Phone:406-219-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist