Healthcare Provider Details

I. General information

NPI: 1851073894
Provider Name (Legal Business Name): AMANDA OSBORNE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 WILMINGTON PIKE STE 230
DAYTON OH
45459-7021
US

IV. Provider business mailing address

2110 LAKE GLEN CT APT D
CENTERVILLE OH
45459-4846
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-3810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: