MEDICARE: AMANDA GANEY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	LPT-30897	AZ

General Provider Information

NPI Number	:	1154062537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GANEY PT, DPT

Provider Business Mailing Address
First Line	:	6096 N RELIANCE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5324
Country	:	US
Telephone Number	:	703-946-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 E RIVER RD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-7645
Country	:	US
Telephone Number	:	520-729-1960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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