| NPI | 1285041384 |
|---|---|
| Former Name | AMANDA JEAN HUMPHREY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1316619) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60786962) |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2021-12-14 |