Individual
AMANDA DEROUCHIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-4088
Mailing address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-4088
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
005342
NY
Other
Enumeration date
05/30/2008
Last updated
05/30/2008
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