Individual
AMANDA W. WORLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, CMTPT
Contact information
Practice address
9980 BROOK RD, UNIT 16, GLEN ALLEN, VA 23059-6501
(804) 550-5730
(804) 550-5733
Mailing address
771 PILOT HOUSE DR, SUITE A, NEWPORT NEWS, VA 23606-1990
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207586
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780931642
MEDICAID QMB PROVIDER ID
VA
01
—
C05954
MEDICARE GROUP PTAN
VA
Enumeration date
08/10/2012
Last updated
02/21/2017
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