Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 12480 | AZ |
NPI | 1013457811 |
---|---|
Provider Name | Amanda Channer |
First Address | Tucson, AZ 85712-1227 |
Second Address | Tucson, AZ 85712-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2017 |
Last Update Date | 01/06/2017 |