Provider Demographics
NPI:1083844229
Name:CAIN, AMANDA MARIE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:CAIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7301 PEAK DR
Mailing Address - Street 2:#150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9037
Mailing Address - Country:US
Mailing Address - Phone:702-804-0026
Mailing Address - Fax:
Practice Address - Street 1:1505 WIGWAM PKWY
Practice Address - Street 2:#240
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8194
Practice Address - Country:US
Practice Address - Phone:702-568-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist