Individual
AMANDA WAMBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1000
Mailing address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(303) 868-9906
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11672796-2401
UT
225100000X
Physical Therapist
PTL.16795
CO
Other
Enumeration date
01/17/2023
Last updated
05/11/2023
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