Provider Demographics
NPI:1790103554
Name:VERIHA, AMANDA SUE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:SUE
Last Name:VERIHA
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 N PARK RD
Mailing Address - Street 2:APT 8
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4026
Mailing Address - Country:US
Mailing Address - Phone:715-938-4442
Mailing Address - Fax:
Practice Address - Street 1:1351 WISCONSIN RIVER DR
Practice Address - Street 2:
Practice Address - City:PORT EDWARDS
Practice Address - State:WI
Practice Address - Zip Code:54469-1041
Practice Address - Country:US
Practice Address - Phone:715-885-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2088225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant