Provider Demographics
NPI:1689045403
Name:AMANDA WOHL, PT, DPT, LLC
Entity Type:Organization
Organization Name:AMANDA WOHL, PT, DPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-248-2208
Mailing Address - Street 1:56 MAYFLOWER HILL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4719
Mailing Address - Country:US
Mailing Address - Phone:207-248-2208
Mailing Address - Fax:
Practice Address - Street 1:56 MAYFLOWER HILL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4719
Practice Address - Country:US
Practice Address - Phone:207-248-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT4102OtherSTATE OF MAINE PHYSICAL THERAPY LICENSE NUMBER