Healthcare Provider Details

I. General information

NPI: 1760479026
Provider Name (Legal Business Name): AMY D VANDREASON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7037 MANLIUS CENTER RD
EAST SYRACUSE NY
13057-2607
US

IV. Provider business mailing address

7037 MANLIUS CENTER RD
EAST SYRACUSE NY
13057-2607
US

V. Phone/Fax

Practice location:
  • Phone: 315-627-0026
  • Fax: 315-627-0389
Mailing address:
  • Phone: 315-627-0026
  • Fax: 315-627-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023212 1
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: