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Individual

AMANDA WIEDER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
1215 E ORANGE ST, LAKELAND, FL 33801-5762
(863) 802-3800
Mailing address
1737 TARAH TRACE DR, BRANDON, FL 33510-2065
(941) 276-6678

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT36566
FL

Other

Enumeration date
01/11/2021
Last updated
01/11/2021
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