Amanda Mambourg, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

013051 Issued in OH

Practice address

5995 Wilcox PL Ste E
Dublin, OH 43016-9267

Phone

(614) 689-2103

Fax

(614) 689-2105

NPI assigned

Jun 6, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amanda Hartman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Akincilar and Prendergast, Inc

  • Physical Therapy Clinic/Center
  • Lexington, MA
  • NPI 1801288824

  Physical Therapist

  NPD
• Prendergast and Rummer Phys Therapy Pelvic Health & Rehabiliation Ctr

  • Physical Therapy Clinic/Center
  • San Francisco, CA
  • NPI 1205112174

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1295576783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5995 WILCOX PL STE E",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430169267",
            "telephone_number": "614-689-2103",
            "fax_number": "614-689-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5995 WILCOX PL STE E",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430169267",
            "telephone_number": "614-689-2103",
            "fax_number": "614-689-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMBOURG",
        "first_name": "AMANDA",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "013051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "HARTMAN",
            "credential": "PHYSICAL THERAPIST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Grant Malone, RBT
• Patricia Malone
• Kendell Michelle Maloney-Seldon, RN
• Tracy Ann Maloney
• Deborah Lee Maloy, RN
• Anicia Manassa
• Jennifer Manazer, DNP, APRN, PMHNP-BC
• Maggie Mae Mancini, ATC, LAT
• Gina Rechelle Manfresca, LPN
• Marisa Mangini, OTD, OTR/L

• Physical Therapist in Dublin, OH
• Providers in Dublin, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.