Provider Demographics
NPI:1215361795
Name:AMMERMAN, AMANDA SCHALL (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SCHALL
Last Name:AMMERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:1800 DAISY STREET EXT
Practice Address - Street 2:SUITE 360
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3254
Practice Address - Country:US
Practice Address - Phone:814-205-4043
Practice Address - Fax:814-205-4055
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396749Medicare PIN