Provider Demographics
NPI:1811226228
Name:FORCE, AMANDA BROOKE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:FORCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88267 TERRITORIAL RD
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9499
Mailing Address - Country:US
Mailing Address - Phone:541-935-0761
Mailing Address - Fax:541-935-0536
Practice Address - Street 1:88267 TERRITORIAL RD
Practice Address - Street 2:SUITE 10A
Practice Address - City:VENETA
Practice Address - State:OR
Practice Address - Zip Code:97487-9499
Practice Address - Country:US
Practice Address - Phone:541-935-0761
Practice Address - Fax:541-935-0536
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT6122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678510Medicaid
ORR179969Medicare UPIN