Provider Demographics
NPI:1659318343
Name:IMPERIALE, AMANDA MARIE (MPT, DPT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:IMPERIALE
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:M
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, DPT
Mailing Address - Street 1:15 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1714
Mailing Address - Country:US
Mailing Address - Phone:570-282-4622
Mailing Address - Fax:
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1418
Practice Address - Country:US
Practice Address - Phone:570-785-2018
Practice Address - Fax:570-785-2061
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist