Provider Demographics
NPI:1366760787
Name:WIEDERHOLT, AMANDA JOY (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOY
Last Name:WIEDERHOLT
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:8006 N THOMAS MEYERS DR
Mailing Address - Street 2:APT B
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-7844
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10000 W 75TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2209
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:913-894-1174
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist