Individual
AMANDA KAE GENNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH4200
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051543221
BCBS
AL
01
—
7160485
AETNA
AL
Enumeration date
10/09/2007
Last updated
01/21/2009
Update your record
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