Provider Demographics
NPI:1851609457
Name:DAVIS, AMANDA Z (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:Z
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:S
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE 285
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3474
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:602-279-6934
Practice Address - Street 1:2195 W CHANDLER BLVD STE 180
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-963-9339
Practice Address - Fax:480-963-4098
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01367600225100000X
AZ012027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist