Provider Demographics
NPI:1528200268
Name:KRESSIN, AMANDA ELIZABETH
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:KRESSIN
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 1:17000 SCIENCE DR
Mailing Address - Street 2:SUITE104
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4420
Mailing Address - Country:US
Mailing Address - Phone:301-860-0237
Mailing Address - Fax:
Practice Address - Street 1:3140 W WARD RD
Practice Address - Street 2:SUITE 206
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3045
Practice Address - Country:US
Practice Address - Phone:410-286-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229445E22Medicare PIN