Provider Demographics
NPI:1689129884
Name:STUART, AMANDA (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:STE 104
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1939
Mailing Address - Country:US
Mailing Address - Phone:818-887-7667
Mailing Address - Fax:818-887-7677
Practice Address - Street 1:7301 MEDICAL CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1939
Practice Address - Country:US
Practice Address - Phone:818-887-7667
Practice Address - Fax:818-887-7677
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist