Provider Demographics
NPI:1447529847
Name:SWINT, AMANDA J (LPTA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:J
Last Name:SWINT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 VERNON HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-5406
Mailing Address - Country:US
Mailing Address - Phone:479-206-1347
Mailing Address - Fax:
Practice Address - Street 1:410 MAIN STREE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833
Practice Address - Country:US
Practice Address - Phone:479-495-9982
Practice Address - Fax:479-495-3407
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2562225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPTA 2562OtherAR STATE BOARD OF PHYSICAL THERAPY