Healthcare Provider Details

I. General information

NPI: 1770559247
Provider Name (Legal Business Name): AMANDA KAYE VAUGHT MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KAYE HELMECZI MPT

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 N VAN BUREN ST SUITE 110
WILMINGTON DE
19802-3851
US

IV. Provider business mailing address

1806 N VAN BUREN ST SUITE 110
WILMINGTON DE
19802-3851
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-8142
  • Fax: 302-654-8143
Mailing address:
  • Phone: 302-654-8142
  • Fax: 302-654-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01158000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10001580
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015139
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: