Provider Demographics
NPI:1669805552
Name:YANULEVICH, AMANDA PAIGE (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:YANULEVICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14843 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8631
Mailing Address - Country:US
Mailing Address - Phone:410-489-7383
Mailing Address - Fax:
Practice Address - Street 1:6300 WOODSIDE CT STE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3210
Practice Address - Country:US
Practice Address - Phone:410-312-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist