Basic Information
| Provider Information | |||||||||
| NPI: | 1770890998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICHTER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | KATE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | REIFLER | ||||||||
| OtherFirstName: | AMANDA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7205 ESTERO BLVD UNIT 5 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339314786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393145118 | ||||||||
| FaxNumber: | 2393145119 | ||||||||
| Practice Location | |||||||||
| Address1: | 7205 ESTERO BLVD UNIT 5 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339314786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393145118 | ||||||||
| FaxNumber: | 2393145119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01364700 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT32747 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.