Provider Demographics
NPI:1932577707
Name:HIMMELHEBER, AMANDA (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HIMMELHEBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 INGRAHAM ST
Mailing Address - Street 2:APT C219
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6449
Mailing Address - Country:US
Mailing Address - Phone:410-245-2989
Mailing Address - Fax:
Practice Address - Street 1:3853 INGRAHAM ST
Practice Address - Street 2:APT C219
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-6449
Practice Address - Country:US
Practice Address - Phone:410-245-2989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872447225100000X
CA43041225100000X
MD27418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist