Amanda Minyard Vidrine, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A6821 Issued in LA

Practice address

4027 I 49 S Service Rd
Opelousas, LA 70570-0757

Phone

(337) 948-4212

Fax

(337) 942-9979

NPI assigned

Apr 11, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336362664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 W PINHOOK RD",
            "address_2": "SUITE A",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032131",
            "telephone_number": "337-233-1307",
            "fax_number": "337-942-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 I 49 S SERVICE RD",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705700757",
            "telephone_number": "337-948-4212",
            "fax_number": "337-942-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINYARD VIDRINE",
        "first_name": "AMANDA",
        "name_prefix": "Prof.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "LA",
            "license": "A6821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LICENSE #",
            "identifier": "A6821",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Opelousas, LA
• Providers in Opelousas, LA by specialty
• Physical Therapy Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.