Provider Demographics
NPI:1922125962
Name:FEHRER, AMANDA KAY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:KAY
Last Name:FEHRER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:BLAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:396 BUCKSKIN RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9225
Mailing Address - Country:US
Mailing Address - Phone:406-560-1536
Mailing Address - Fax:
Practice Address - Street 1:6325 JACKRABBIT LN
Practice Address - Street 2:SUITE A
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9128
Practice Address - Country:US
Practice Address - Phone:406-388-4988
Practice Address - Fax:406-388-6188
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT62021OtherBCBS
MT0535194Medicaid
MT0535194Medicaid