Provider Demographics
NPI:1114351624
Name:WEGH, AMANDA LINDSAY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LINDSAY
Last Name:WEGH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:LINDSAY
Other - Last Name:WEGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 GUILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:302-766-1187
Mailing Address - Fax:
Practice Address - Street 1:141 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713
Practice Address - Country:US
Practice Address - Phone:301-432-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163944225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant