Provider Demographics
NPI:1871138321
Name:AUSTIN, AMANDA LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:MIKOLAJCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 SHARON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1118 W BALTIMORE PIKE STE 302
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-6107
Practice Address - Country:US
Practice Address - Phone:610-480-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist