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Individual

AMY MELISSA WIEDLICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSPT

Contact information

Practice address
119 S MAIN RD, MOUNTAIN TOP, PA 18707-1903
(570) 208-5571
(570) 208-5548
Mailing address
27 MAIN ST, DALLAS, PA 18612-1603
(570) 208-5571
(570) 208-5548

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015077
PA

Other

Enumeration date
07/26/2010
Last updated
07/26/2010
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