Provider Demographics
NPI:1417380080
Name:WESTERGARD, AMANDA N (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:N
Last Name:WESTERGARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19619 S 190TH DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6888
Mailing Address - Country:US
Mailing Address - Phone:760-408-0283
Mailing Address - Fax:480-809-9302
Practice Address - Street 1:19619 S 190TH DR
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6888
Practice Address - Country:US
Practice Address - Phone:760-408-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist