Provider Demographics
NPI:1356942585
Name:WELDON, AMANDA ROSE (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:WELDON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CORBIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2913
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:1690 HIGHWAY 192 W
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1673
Practice Address - Country:US
Practice Address - Phone:606-877-3231
Practice Address - Fax:606-877-3632
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist