Provider Demographics
NPI:1760479026
Name:VANDREASON, AMY D (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:D
Last Name:VANDREASON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7037 MANLIUS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2607
Mailing Address - Country:US
Mailing Address - Phone:315-627-0026
Mailing Address - Fax:315-627-0389
Practice Address - Street 1:7037 MANLIUS CENTER RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2607
Practice Address - Country:US
Practice Address - Phone:315-627-0026
Practice Address - Fax:315-627-0389
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
023212 1225100000X
NY023212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9416Medicare ID - Type Unspecified