Provider Demographics
NPI:1861044653
Name:VANDERMARK, AMY LOUISE (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:VANDERMARK
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 1:215 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-8828
Mailing Address - Country:US
Mailing Address - Phone:570-546-4291
Mailing Address - Fax:570-546-4218
Practice Address - Street 1:215 E WATER ST
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8828
Practice Address - Country:US
Practice Address - Phone:570-546-4291
Practice Address - Fax:570-546-4218
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT003762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist