Provider Demographics
NPI:1457608762
Name:STANLEY, AMANDA G (DPT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:G
Last Name:STANLEY
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 1:354 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1418
Mailing Address - Country:US
Mailing Address - Phone:570-785-2018
Mailing Address - Fax:570-785-3575
Practice Address - Street 1:1000 MEADE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3195
Practice Address - Country:US
Practice Address - Phone:570-342-5333
Practice Address - Fax:570-342-5334
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist