Basic Information
| Provider Information | |||||||||
| NPI: | 1144692138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WU | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 KINGS HWY EAST | ||||||||
| Address2: | |||||||||
| City: | HADDONFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007745516 | ||||||||
| FaxNumber: | 8564291613 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 CALDEWELL ROAD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563481175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2015 | ||||||||
| LastUpdateDate: | 10/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01612100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40QA01612100 | 01 | LICENSE | OTHER |