Healthcare Provider Details

I. General information

NPI: 1649054974
Provider Name (Legal Business Name): AMANDA THERESA WEATHERBEE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA VON SPIEGEL

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 BARLOW RD
HUDSON OH
44236-3709
US

IV. Provider business mailing address

231 SALT CREEK RUN
PENINSULA OH
44264-9464
US

V. Phone/Fax

Practice location:
  • Phone: 330-805-9988
  • Fax:
Mailing address:
  • Phone: 330-687-4883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: