Provider Demographics
NPI:1962661371
Name:KRIEBEL, AMANDA LEE (MPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:KRIEBEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 3RD ST APT 8
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4422
Mailing Address - Country:US
Mailing Address - Phone:858-692-3883
Mailing Address - Fax:
Practice Address - Street 1:312 S CEDROS AVE STE 206
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1942
Practice Address - Country:US
Practice Address - Phone:619-787-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist