Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

AMANDA ELLIS

Active Sole Proprietor

Physical Disabilities Residential Treatment Facility · SAN TAN VALLEY, AZ

Registration Details

NPI Number: 1194198697
Provider Type: Individual
Gender: Female
NPI Issued: Nov 5, 2015 (10.459500647768 yrs)
Last Updated: Nov 5, 2015
License: D05686544 (AZ)
Sole Proprietor: Yes

Practice Information

Address: 381 EAST BROOK STREET

SAN TAN VALLEY, AZ, 85140
Browse AZ providers · Browse ZIP 85140
Phone: 4804952839
Primary Specialty: Physical Disabilities Residential Treatment Facility
320700000X

Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.