Provider Demographics
NPI:1841696440
Name:HERLEIN, AMANDA R (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:HERLEIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:R
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:12746 CORBY ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3423
Mailing Address - Country:US
Mailing Address - Phone:402-740-5951
Mailing Address - Fax:
Practice Address - Street 1:20650 GLENN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022
Practice Address - Country:US
Practice Address - Phone:402-289-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist