Provider Demographics
NPI:1962808931
Name:ARANDA, AMANDA PEARL (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PEARL
Last Name:ARANDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 MORTON ST # 1111
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-5015
Mailing Address - Country:US
Mailing Address - Phone:620-697-4331
Mailing Address - Fax:620-697-4322
Practice Address - Street 1:451 MORTON ST # 1111
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-5015
Practice Address - Country:US
Practice Address - Phone:620-697-4331
Practice Address - Fax:620-697-4322
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist