Individual
AMANDA R DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1072 E OLD CANYON CT, FLAGSTAFF, AZ 86001-6006
(928) 220-7504
Mailing address
1072 E OLD CANYON CT, FLAGSTAFF, AZ 86001-6006
(928) 607-4037
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7738
AZ
2251X0800X
Orthopedic Physical Therapist
7738
AZ
2251X0800X
Orthopedic Physical Therapist
7738
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00432914
RAILROAD MEDICARE
AZ
Enumeration date
07/30/2007
Last updated
12/06/2023
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