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NPI Code Detail

MEDICARE: MRS. AMANDA JOY VANDERVORT MPT

MEDICARE: MRS. AMANDA JOY VANDERVORT MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT010156OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
211896519OTHEROHCAQH

General Provider Information

NPI Number : 1174520712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA JOY VANDERVORT MPT
Provider Business Mailing Address
First Line : 5000 ROCKSIDE RD STE 500
Second Line :
City : INDEPENDENCE
State : OH
Zip : 44131-2178
Country : US
Telephone Number : 216-459-2846
Fax Number : 216-901-2803
Provider Business Practice Location Address
First Line : 5520 BROADVIEW RD FRNT
Second Line :
City : PARMA
State : OH
Zip : 44134-1605
Country : US
Telephone Number : 216-749-6650
Fax Number : 216-749-1655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 11/06/2019

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Directions to “ MRS. AMANDA JOY VANDERVORT MPT” Practice Location

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