Provider Demographics
NPI:1386243004
Name:BLIEK, AMANDA LIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LIN
Last Name:BLIEK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:LIN
Other - Last Name:WINDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:816 INDEPENDENCE BLVD STE 3F
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6010
Mailing Address - Country:US
Mailing Address - Phone:757-363-6178
Mailing Address - Fax:757-363-6476
Practice Address - Street 1:816 INDEPENDENCE BLVD STE 3F
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-363-6178
Practice Address - Fax:757-363-6476
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist