Individual
MRS. AMANDA JOY VANDERVORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
5520 BROADVIEW RD FRNT, PARMA, OH 44134-1605
(216) 749-6650
(216) 749-1655
Mailing address
5000 ROCKSIDE RD STE 500, INDEPENDENCE, OH 44131-2178
(216) 459-2846
(216) 901-2803
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT010156
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11896519
CAQH
OH
05
—
2353797
—
OH
Enumeration date
06/28/2005
Last updated
11/06/2019
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