Provider Demographics
NPI:1609614627
Name:DEKLEINE, AMANDA (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DEKLEINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CLAMER RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3202
Mailing Address - Country:US
Mailing Address - Phone:609-240-9078
Mailing Address - Fax:
Practice Address - Street 1:220 TRIANGLE RD UNIT 229
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8102
Practice Address - Country:US
Practice Address - Phone:908-681-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029901225100000X
NJ40QA02033400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist