Provider Demographics
NPI:1083811939
Name:ELMASIAN, AMANDA D (PT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:D
Last Name:ELMASIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:PECSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7679 EL RITO WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5407
Mailing Address - Country:US
Mailing Address - Phone:916-397-3698
Mailing Address - Fax:
Practice Address - Street 1:7679 EL RITO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5407
Practice Address - Country:US
Practice Address - Phone:916-397-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist