Provider Demographics
NPI:1669602082
Name:MCCORMICK, AMANDA BETH (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6620 FLY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4282
Mailing Address - Country:US
Mailing Address - Phone:315-464-6543
Mailing Address - Fax:315-464-4753
Practice Address - Street 1:6620 FLY RD STE 201
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-4282
Practice Address - Country:US
Practice Address - Phone:315-464-6543
Practice Address - Fax:315-464-4753
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0315562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic