MEDICARE: MRS. AMANDA MARIE IRELAND DPT

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	225100000X	Physical Therapist	J1-0002833	DE

General Provider Information

NPI Number	:	1821227265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA MARIE IRELAND DPT

Provider Business Mailing Address
First Line	:	659 S SALISBURY BLVD STE 1B
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801-5458
Country	:	US
Telephone Number	:	410-831-3226
Fax Number	:	410-572-4041

Provider Business Practice Location Address
First Line	:	21 W CLARKE AVE STE 1500
Second Line	:
City	:	MILFORD
State	:	DE
Zip	:	19963-1857
Country	:	US
Telephone Number	:	302-491-6529
Fax Number	:	302-503-7160

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

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	12/26/2023

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