Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 62031917 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 41353 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 8820640-2401 | UT |
NPI | 1457696221 |
---|---|
Provider Name | Ms. Amanda E Lancaster |
First Address | Murray, UT 84107-6165 |
Second Address | Murray, UT 84107-6165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2012 |
Last Update Date | 21/01/2016 |