Provider Demographics
NPI:1295073096
Name:HOLLENBACH, AMANDA (MS, RD, LDN, LAT,ATC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HOLLENBACH
Suffix:
Gender:F
Credentials:MS, RD, LDN, LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 AUTUMN RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4355
Mailing Address - Country:US
Mailing Address - Phone:267-908-4825
Mailing Address - Fax:
Practice Address - Street 1:321 AUTUMN RIVER RUN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4355
Practice Address - Country:US
Practice Address - Phone:267-908-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0036782255A2300X
PADN004044133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN004044OtherPA LICENSE NUMBER
PART003678OtherPA LICENSE NUMBER