Provider Demographics
NPI:1245273234
Name:GRATER, AMANDA LYNN (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:GRATER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:VICKODIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1136 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2025
Mailing Address - Country:US
Mailing Address - Phone:724-601-4140
Mailing Address - Fax:
Practice Address - Street 1:2580 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1294
Practice Address - Country:US
Practice Address - Phone:724-847-1180
Practice Address - Fax:724-847-7592
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016662L225100000X
PADAPT001462172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172V00000XOther Service ProvidersCommunity Health Worker