Provider Demographics
NPI:1245855170
Name:LEDALL, AMANDA LYNNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNNE
Last Name:LEDALL
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 1:337 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2521
Mailing Address - Country:US
Mailing Address - Phone:308-293-6249
Mailing Address - Fax:
Practice Address - Street 1:510 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1708
Practice Address - Country:US
Practice Address - Phone:402-646-2007
Practice Address - Fax:402-646-2008
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist