Provider Demographics
NPI:1578835765
Name:OBERHEU, AMANDA (CMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:OBERHEU
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 1/2 E GRAND RIVER AVE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4323
Mailing Address - Country:US
Mailing Address - Phone:517-203-1113
Mailing Address - Fax:
Practice Address - Street 1:201 1/2 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 19
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4323
Practice Address - Country:US
Practice Address - Phone:517-203-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINOT REQUIRED IN MICH172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist