Individual
PROF. AMANDA MINYARD VIDRINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4027 I 49 S SERVICE RD, OPELOUSAS, LA 70570-0757
(337) 948-4212
(337) 942-9979
Mailing address
420 W PINHOOK RD, SUITE A, LAFAYETTE, LA 70503-2131
(337) 233-1307
(337) 942-9979
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A6821
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A6821
PTA LICENSE #
LA
Enumeration date
04/11/2007
Last updated
07/08/2007
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