Provider Demographics
NPI:1164760419
Name:MCCABE, AMANDA H (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:H
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BETH
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 SALLITT DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2279
Mailing Address - Country:US
Mailing Address - Phone:410-604-2162
Mailing Address - Fax:410-604-2975
Practice Address - Street 1:155 SALLITT DR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2279
Practice Address - Country:US
Practice Address - Phone:410-604-2162
Practice Address - Fax:410-604-2975
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD24382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC272245ZDTRMedicare PIN
MD272811ZDR9Medicare PIN