Provider Demographics
NPI:1942493192
Name:BUDACH, AMANDA (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BUDACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:MANZOEILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8115 E INDIAN BEND RD
Mailing Address - Street 2:STE 123
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250
Mailing Address - Country:US
Mailing Address - Phone:480-951-6451
Mailing Address - Fax:
Practice Address - Street 1:8815 E INDIAN BEND RD
Practice Address - Street 2:STE 123
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250
Practice Address - Country:US
Practice Address - Phone:480-951-6451
Practice Address - Fax:630-724-0978
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015359225100000X
AZ8812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCD3789OtherMEDICARE RAILROAD GROUP NUMBER
IL1619908OtherBCBS IL GROUP
IL568080OtherMEDICARE GROUP NUMBER
ILP00623070OtherMEDICARE RAILROAD NUMBER
ILP00623070OtherMEDICARE RAILROAD NUMBER