Provider Demographics
NPI:1487842266
Name:REGER, AMANDA BETHANY (MPT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:BETHANY
Last Name:REGER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:BETHANY
Other - Last Name:VEENHUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-424-8225
Mailing Address - Fax:937-424-8254
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-424-8225
Practice Address - Fax:937-424-8254
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-09797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist