Provider Demographics
NPI:1194753822
Name:TVEDT, AMANDA J (DPT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:TVEDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:RAVENSCROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:5956 E PIMA ST STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4375
Practice Address - Country:US
Practice Address - Phone:520-885-4636
Practice Address - Fax:520-885-4736
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-007670225100000X
CAPT29677225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT29677AMedicare PIN
AZ115559Medicare PIN