Individual
AMANDA BROGNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6595 B E ROOSEVELT BLVD, PHILA, PA 19149
(215) 743-2332
Mailing address
6595 B E ROOSEVELT BLVD, PHILA, PA 19149
(215) 743-2332
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OC010804
PA
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2877
LICENSE #
AZ
Enumeration date
08/21/2006
Last updated
01/15/2025
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