Provider Demographics
NPI:1952694440
Name:POLIZZI, AMANDA JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:POLIZZI
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 1:4698 W LAKE RD
Mailing Address - Street 2:APT. 2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1412
Mailing Address - Country:US
Mailing Address - Phone:814-520-2129
Mailing Address - Fax:
Practice Address - Street 1:8300 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-8701
Practice Address - Country:US
Practice Address - Phone:814-474-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008358225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant