Provider Demographics
NPI:1720671316
Name:KRONEN, AMANDA ALICE (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALICE
Last Name:KRONEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ALICE
Other - Last Name:LOBDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:14884 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8451
Mailing Address - Country:US
Mailing Address - Phone:218-824-5027
Mailing Address - Fax:
Practice Address - Street 1:14884 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8451
Practice Address - Country:US
Practice Address - Phone:218-824-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1205225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant