Individual
AMANDA SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
108 BURNHAM PL, NEWPORT NEWS, VA 23606-2611
(757) 870-0298
Mailing address
108 BURNHAM PL, NEWPORT NEWS, VA 23606-2611
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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