Provider Demographics
NPI:1437722758
Name:ROBERTS, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-6532
Mailing Address - Country:US
Mailing Address - Phone:507-360-9187
Mailing Address - Fax:
Practice Address - Street 1:105 GLEN HAVEN DR
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-4010
Practice Address - Country:US
Practice Address - Phone:218-864-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant