Provider Demographics
NPI:1215333513
Name:AMOS, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:AMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SW 155TH LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1524
Mailing Address - Country:US
Mailing Address - Phone:954-444-0338
Mailing Address - Fax:
Practice Address - Street 1:2229 N COMMERCE PKWY STE 200A
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3282
Practice Address - Country:US
Practice Address - Phone:954-659-8986
Practice Address - Fax:954-659-8987
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist