Provider Demographics
NPI:1306185665
Name:GOTSCHALL, AMANDA ECCLES (DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ECCLES
Last Name:GOTSCHALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:ECCLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:209 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4228
Practice Address - Country:US
Practice Address - Phone:408-307-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist