Provider Demographics
NPI:1346364379
Name:GEORGE, AMANDA MELANIE (MSPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MELANIE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GRANNERY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2304
Mailing Address - Country:US
Mailing Address - Phone:215-855-6132
Mailing Address - Fax:
Practice Address - Street 1:1043 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5338
Practice Address - Country:US
Practice Address - Phone:215-361-0322
Practice Address - Fax:215-361-8719
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012244L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist