Provider Demographics
NPI:1912253162
Name:O'MALLEY, AMANDA FUNK (DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:FUNK
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:ELLEN
Other - Last Name:FUNK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:530 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-9228
Mailing Address - Country:US
Mailing Address - Phone:717-330-6716
Mailing Address - Fax:
Practice Address - Street 1:530 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9228
Practice Address - Country:US
Practice Address - Phone:717-330-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60296371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist