Provider Demographics
NPI:1215209234
Name:ROURA, AMANDA ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:ROURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 SW 149TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4054
Mailing Address - Country:US
Mailing Address - Phone:786-200-1881
Mailing Address - Fax:
Practice Address - Street 1:5027 SW 149TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4054
Practice Address - Country:US
Practice Address - Phone:786-200-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist