Individual
AMANDA L BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T., D.P.T.
Contact information
Practice address
1909 VISTA DR, LARAMIE, WY 82070-5530
(307) 721-8024
(307) 742-3093
Mailing address
1909 VISTA DR, LARAMIE, WY 82070-5530
(307) 721-8024
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 1501
WY
Other
Enumeration date
08/06/2013
Last updated
07/07/2015
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