Healthcare Provider Details

I. General information

NPI: 1194650846
Provider Name (Legal Business Name): AMANDA JO WASEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ENGLEWOOD AVE
WHEELING WV
26003-5001
US

IV. Provider business mailing address

35 ENGLEWOOD AVE
WHEELING WV
26003-5001
US

V. Phone/Fax

Practice location:
  • Phone: 304-639-4422
  • Fax:
Mailing address:
  • Phone: 304-639-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003083
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI004193
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: