Provider Demographics
NPI:1437516465
Name:BERTOVICH, AMANDA SUE (PT, DPT, MHA, AT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SUE
Last Name:BERTOVICH
Suffix:
Gender:F
Credentials:PT, DPT, MHA, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27038 WINONA RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44634-9719
Mailing Address - Country:US
Mailing Address - Phone:330-429-0236
Mailing Address - Fax:
Practice Address - Street 1:27038 WINONA RD
Practice Address - Street 2:
Practice Address - City:HOMEWORTH
Practice Address - State:OH
Practice Address - Zip Code:44634-9719
Practice Address - Country:US
Practice Address - Phone:330-429-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0191952081S0010X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer