Provider Demographics
NPI:1801019708
Name:GOTTSCHALK, AMANDA K (MPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:GOTTSCHALK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:407-865-7153
Mailing Address - Fax:407-865-7159
Practice Address - Street 1:901 DOUGLAS AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2058
Practice Address - Country:US
Practice Address - Phone:407-865-7153
Practice Address - Fax:407-865-7159
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT195712251X0800X, 225100000X
NCP17203225100000X
OHPT0203412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic