Provider Demographics
NPI:1457696221
Name:LANCASTER, AMANDA E (MPT, DPT, NCS)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:E
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MPT, DPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 S 250 E STE G50
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6165
Mailing Address - Country:US
Mailing Address - Phone:801-314-5000
Mailing Address - Fax:
Practice Address - Street 1:5770 S 250 E STE G50
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6165
Practice Address - Country:US
Practice Address - Phone:801-314-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62031917225100000X
NY413532251N0400X
UT8820640-24012251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology