Healthcare Provider Details

I. General information

NPI: 1912284118
Provider Name (Legal Business Name): 393AMANDA JENNIFER HADDAD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JENNIFER GEDNEY PT

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 NORTHFIELD RD
HIGHLAND HILLS OH
44128-2811
US

IV. Provider business mailing address

2743 MARBLEVISTA BLVD
COLUMBUS OH
43204-9016
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-9700
  • Fax:
Mailing address:
  • Phone: 440-759-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.013498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: