Provider Demographics
NPI:1902225022
Name:ABERNATHY, AMANDA BROOKE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:BROOKE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 COLUMBIA ROAD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-250-5767
Mailing Address - Fax:440-250-5768
Practice Address - Street 1:850 COLUMBIA ROAD
Practice Address - Street 2:SUITE #110
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-250-5767
Practice Address - Fax:440-250-5768
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist