Provider Demographics
NPI:1437584109
Name:ROTONDO, AMANDA LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYNN
Last Name:ROTONDO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:GAAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:348 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2007
Mailing Address - Country:US
Mailing Address - Phone:917-991-2709
Mailing Address - Fax:
Practice Address - Street 1:10 WOODBRIDGE CENTER DR.
Practice Address - Street 2:SUITE 102
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-855-0380
Practice Address - Fax:732-855-0384
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01511000225100000X
NY036831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist