Individual
AMANDA L WALRATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2462 JOHNSON STREET RD, KEOKUK, IA 52632-9736
(319) 524-1041
(319) 524-1041
Mailing address
2462 JOHNSON STREET RD, KEOKUK, IA 52632-9736
(319) 524-1041
(319) 524-1041
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03212
IA
225100000X
Physical Therapist
112711
MO
225100000X
Physical Therapist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003432008
BCBS PRIVIDER NUMBER
IL
Enumeration date
08/10/2006
Last updated
07/08/2007
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