Provider Demographics
NPI:1104040237
Name:DUNNE, AMANDA J (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:DUNNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JAYE
Other - Last Name:BALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1175 E PARKCENTER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6752
Mailing Address - Country:US
Mailing Address - Phone:208-344-2525
Mailing Address - Fax:208-344-3056
Practice Address - Street 1:1175 E PARKCENTER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6752
Practice Address - Country:US
Practice Address - Phone:208-344-2525
Practice Address - Fax:208-344-3056
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008743225100000X
IDPT-5431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOL35F284Medicare PIN
MO223441521Medicare PIN