Provider Demographics
NPI:1801091186
Name:CLINGAN, AMANDA SUSAN (PTA)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:SUSAN
Last Name:CLINGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 6TH ST SW
Mailing Address - Street 2:APT. 4
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-4083
Mailing Address - Country:US
Mailing Address - Phone:515-370-4358
Mailing Address - Fax:
Practice Address - Street 1:3661 ROCHESTER AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9271
Practice Address - Country:US
Practice Address - Phone:319-351-7460
Practice Address - Fax:319-341-6229
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01117225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant