Individual
AMY KATHRYN VANDETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, ATC
Contact information
Practice address
646 HOLLEY RD, SWEET HOME, OR 97386-3344
(541) 451-6272
(541) 451-6278
Mailing address
38444 RIVER DR, LEBANON, OR 97355-9318
(541) 259-5105
(541) 451-6278
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8079
OR
2255A2300X
Athletic Trainer
AT-AT-120868
OR
Other
Enumeration date
03/07/2007
Last updated
09/11/2025
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