Individual ProviderAmanda S DouglassPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4201 Belfort Rd, Jacksonville, FL 32216-1431(904) 296-5811(904) 471-5117PECOS EnrollmentBased on the most recent information from CMS, provider Amanda S Douglass does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1376748327Provider TypeIndividualFull NameDouglass, Amanda STitleMrs.CredentialDPTGenderFemaleSole ProprietorNoEnumeration Date6/19/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address4201 Belfort Rd, Jacksonville, FL 32216-1431Phone(904) 296-5811Fax(904) 296-5810Mailing LocationMailing Address210 16th St Unit C, Saint Augustine, FL 32080-6595Phone(904) 471-5117FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT22464Florida