| NPI | 1821386376 |
|---|---|
| Former Name | AMANDA SHAKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-009403) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 9403pt) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2021-03-25 |