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General NPI Number Information
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NPI Number | 1740721133
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Entity Type | Individual
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Provider Name | AMANDA OFF PT, DPT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 03/27/2022
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Provider Practice Location Address
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Address Line | 600 ROE AVE
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City | ELMIRA
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State | NY
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Zip | 14905-1676
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Country | US
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Telephone | 607-737-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 3381 STATE HIGHWAY 8
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City | SOUTH NEW BERLIN
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State | NY
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Zip | 13843-2121
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Country | US
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Telephone | 607-373-0850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 004257
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 046310
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License Number State | NY
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