Provider Demographics
NPI:1528503489
Name:FROST, AMANDA (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2806
Mailing Address - Country:US
Mailing Address - Phone:518-762-4548
Mailing Address - Fax:518-736-1570
Practice Address - Street 1:201 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2806
Practice Address - Country:US
Practice Address - Phone:518-762-4548
Practice Address - Fax:518-736-1570
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038646-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10035694OtherCDPHP
NY353581OtherMVP
NY00394849Medicaid
NYQ44191OtherEBCBS