Amanda J Forstrom, PT
Individual provider Active NPI Specialist · Fairmont, MN
NPI 1386615375 · NPPES record last updated Aug 25, 2014
Key facts
- NPI
- 1386615375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 6460 (MN)
- Practice address
- 717 S State St
Suite 900
Fairmont, MN 56031-4469 - Phone
- (507) 237-4949
- Fax
- (507) 238-3377
- NPI assigned
- Jan 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6460 | MN | MD | Audiologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Partners Inc | Past | Accepting new patients | |
| Therapy Partners, Inc | Past | Accepting new patients | |
| Therapy Partners, Ins | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 6460 | MN | Yes |
Addresses
Primary practice location
717 S State St
Suite 900
Fairmont, MN 56031-4469
Mailing address
912 S Broadway St
New Ulm, MN 56073-3409
Phone (507) 359-4393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124G2FO | Other | MN | BXBS |
Other providers in Fairmont, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.