Healthcare Provider Details

I. General information

NPI: 1528503489
Provider Name (Legal Business Name): AMANDA FROST PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MADISON AVE
JOHNSTOWN NY
12095-2806
US

IV. Provider business mailing address

201 W MADISON AVE
JOHNSTOWN NY
12095-2806
US

V. Phone/Fax

Practice location:
  • Phone: 518-762-4548
  • Fax: 518-736-1570
Mailing address:
  • Phone: 518-762-4548
  • Fax: 518-736-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038646-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: