Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 25196 | MD |
N | 2251N0400X | Physical Therapist - Neurology | 003427 | WV |
N | 2251X0800X | Physical Therapist - Orthopedic | 003427 | WV |
NPI | 1639577810 |
---|---|
Provider Name | Amanda Julienne Tyler |
First Address | Hagerstown, MD 21742-6797 |
Second Address | Hagerstown, MD 21742-6711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2014 |
Last Update Date | 24/04/2020 |