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NPI Code Detail

MEDICARE: MISS AMANDA SUSAN CLINGAN PTA

MEDICARE: MISS AMANDA SUSAN CLINGAN PTA
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
1225200000XPhysical Therapy Assistant01117IA

General Provider Information

NPI Number : 1801091186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS AMANDA SUSAN CLINGAN PTA
Provider Business Mailing Address
First Line : 2951 6TH ST SW
Second Line : APT. 4
City : CEDAR RAPIDS
State : IA
Zip : 52404-4083
Country : US
Telephone Number : 515-370-4358
Fax Number :
Provider Business Practice Location Address
First Line : 3661 ROCHESTER AVE
Second Line :
City : IOWA CITY
State : IA
Zip : 52245-9271
Country : US
Telephone Number : 319-351-7460
Fax Number : 319-341-6229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2007
Last Update Date : 07/08/2007

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