| NPI | 1528511284 |
|---|---|
| Former Name | AMANDA KELLEY WALTERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5412) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11047) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2023-03-09 |