Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2126460 | TX |
Y | 2081S0010X | Sports Medicine | 2305213026 | VA |
Y | 213ES0000X | Sports Medicine | 2305213026 | VA |
N | 225100000X | Physical Therapist | 2305213029 | VA |
NPI | 1255811881 |
---|---|
Provider Name | Miss Amanda Jane Priest |
First Address | Boston, MA 02241-3171 |
Second Address | Suffolk, VA 23434-8168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 01/07/2021 |