Provider Demographics
NPI:1427710565
Name:ROITHMEIER, AMANDA (SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ROITHMEIER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 CENTRAL AVE UNIT 3013
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-9066
Mailing Address - Country:US
Mailing Address - Phone:971-222-5352
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4205
Practice Address - Country:US
Practice Address - Phone:321-732-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist