Provider Demographics
NPI:1598065997
Name:HERROLD, AMANDA JEAN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JEAN
Last Name:HERROLD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:CROSETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:404 RIVERVIEW TER
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN
Mailing Address - State:PA
Mailing Address - Zip Code:17018-9104
Mailing Address - Country:US
Mailing Address - Phone:201-248-2256
Mailing Address - Fax:
Practice Address - Street 1:404 RIVERVIEW TER
Practice Address - Street 2:
Practice Address - City:DAUPHIN
Practice Address - State:PA
Practice Address - Zip Code:17018-9104
Practice Address - Country:US
Practice Address - Phone:201-248-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist