Provider Demographics
NPI:1568750438
Name:PEELER, AMANDA LOUISE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LOUISE
Last Name:PEELER
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 1:23121 ANTONIO PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2660
Mailing Address - Country:US
Mailing Address - Phone:949-742-0701
Mailing Address - Fax:
Practice Address - Street 1:15525 POMERADO RD
Practice Address - Street 2:STE D4
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2435
Practice Address - Country:US
Practice Address - Phone:858-674-1600
Practice Address - Fax:858-674-1606
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFG856ZMedicare PIN