Provider Demographics
NPI:1912271784
Name:MOSHER, AMANDA M (DPT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:MOSHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHAMPLAIN CMNS
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-2049
Mailing Address - Country:US
Mailing Address - Phone:802-524-1155
Mailing Address - Fax:802-524-2664
Practice Address - Street 1:2 CHAMPLAIN CMNS
Practice Address - Street 2:SUITE 4
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2049
Practice Address - Country:US
Practice Address - Phone:802-524-1155
Practice Address - Fax:802-524-2664
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.00774402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic