Provider Demographics
NPI:1952140238
Name:KLEIN, AMANDA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2940 E BANNER GATEWAY DR STE 425
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2177
Mailing Address - Country:US
Mailing Address - Phone:480-813-7900
Mailing Address - Fax:
Practice Address - Street 1:2940 E BANNER GATEWAY DR STE 425
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2177
Practice Address - Country:US
Practice Address - Phone:480-813-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033599208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation