Provider Demographics
NPI:1346529799
Name:ST. JOHN, AMANDA L (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:ST. JOHN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:POTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1060 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5032
Mailing Address - Country:US
Mailing Address - Phone:978-660-5483
Mailing Address - Fax:
Practice Address - Street 1:145 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2560
Practice Address - Country:US
Practice Address - Phone:978-598-3155
Practice Address - Fax:978-365-5600
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist