Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 9442 | AZ |
Y | 2251N0400X | Physical Therapist - Neurology | 9442 | AZ |
NPI | 1619221991 |
---|---|
Provider Name | Amanda Petty |
First Address | Tucson, AZ 85743-1215 |
Second Address | Tucson, AZ 85723-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2012 |
Last Update Date | 10/09/2019 |