MEDICARE: AMANDA ROBERTS

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

General Provider Information

NPI Number	:	1437722758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ROBERTS

Provider Business Mailing Address
First Line	:	1302 16TH AVE
Second Line	:
City	:	KEARNEY
State	:	NE
Zip	:	68845-6532
Country	:	US
Telephone Number	:	507-360-9187
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 GLEN HAVEN DR
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-4010
Country	:	US
Telephone Number	:	218-864-5231
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	07/23/2021

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Directions to “ AMANDA ROBERTS ” Practice Location

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