Provider Demographics
NPI:1396039244
Name:IADAROLA, AMY CATHERINE (CERTIFIED ROLFER)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:CATHERINE
Last Name:IADAROLA
Suffix:
Gender:F
Credentials:CERTIFIED ROLFER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3938 LANTERN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2321
Mailing Address - Country:US
Mailing Address - Phone:301-908-7847
Mailing Address - Fax:
Practice Address - Street 1:3938 LANTERN DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-2321
Practice Address - Country:US
Practice Address - Phone:301-908-7847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04594172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist