| NPI | 1245273234 |
|---|---|
| Former Name | AMANDA LYNN VICKODIL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016662L) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: PA DAPT001462) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2010-08-11 |