Provider Demographics
NPI:1508159922
Name:HAUCK, AMANDA JANE (ATC, PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:HAUCK
Suffix:
Gender:F
Credentials:ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 HARRY SAUNER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-9477
Mailing Address - Country:US
Mailing Address - Phone:937-393-4949
Mailing Address - Fax:937-393-4737
Practice Address - Street 1:716 HARRY SAUNER RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-9477
Practice Address - Country:US
Practice Address - Phone:937-393-4949
Practice Address - Fax:937-393-4737
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.011994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist