MEDICARE: AMANDA SANER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	652	NE

General Provider Information

NPI Number	:	1396297362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SANER

Provider Business Mailing Address
First Line	:	12315 WIRT ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-2593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12315 WIRT ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-2593
Country	:	US
Telephone Number	:	402-677-7089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	10/26/2016

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Directions to “ AMANDA SANER ” Practice Location

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