| NPI | 1669685624 |
|---|---|
| Former Name | AMANDA JO WHEATLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25660) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA AT 8377) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2022-07-21 |