Provider Demographics
NPI:1366774838
Name:WOODHEAD, AMANDA EVE (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:EVE
Last Name:WOODHEAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:EVE
Other - Last Name:LUEKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2845 SOUTH 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-489-1999
Mailing Address - Fax:402-489-4153
Practice Address - Street 1:2845 SOUTH 70TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-489-1999
Practice Address - Fax:402-489-4153
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist