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NPI Code Detail

MEDICARE: MS. AMANDA MARIE IMPERIALE MPT, DPT

MEDICARE: MS. AMANDA MARIE IMPERIALE MPT, DPT
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 TherapistPT016574PA

General Provider Information

NPI Number : 1659318343
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA MARIE IMPERIALE MPT, DPT
Provider Business Mailing Address
First Line : 15 GILBERT ST
Second Line :
City : CARBONDALE
State : PA
Zip : 18407-1714
Country : US
Telephone Number : 570-282-4622
Fax Number :
Provider Business Practice Location Address
First Line : 354 MAIN ST
Second Line :
City : FOREST CITY
State : PA
Zip : 18421-1418
Country : US
Telephone Number : 570-785-2018
Fax Number : 570-785-2061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 05/31/2017

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