Provider Demographics
NPI:1912118019
Name:WEINER, AMANDA (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WEINER
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 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-413-3900
Mailing Address - Fax:402-413-3909
Practice Address - Street 1:17500 BURKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2244
Practice Address - Country:US
Practice Address - Phone:402-401-3915
Practice Address - Fax:402-401-3201
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477701Medicaid