Individual
AMANDA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
381 EAST BROOK STREET, SAN TAN VALLEY, AZ 85140
(480) 495-2839
Mailing address
381 E BROOK ST, SAN TAN VALLEY, AZ 85140
(480) 495-2839
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
D05686544
AZ
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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