Provider Demographics
NPI:1750553657
Name:AUTRAN, AMANDA MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARGARET
Last Name:AUTRAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:MARGARET
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5391
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:754 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2544
Practice Address - Country:US
Practice Address - Phone:909-460-4155
Practice Address - Fax:909-988-4414
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28403OtherLICENSE
CAPT28403OtherLICENSE
CADA841YMedicare PIN