Provider Demographics
NPI:1386996700
Name:RADEMACHER, AMBER JO (PTA)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JO
Last Name:RADEMACHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 S HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-5535
Mailing Address - Country:US
Mailing Address - Phone:812-486-7667
Mailing Address - Fax:
Practice Address - Street 1:1764 TROY RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8210
Practice Address - Country:US
Practice Address - Phone:812-254-2750
Practice Address - Fax:812-254-2750
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004264A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant