Healthcare Provider Details

I. General information

NPI: 1801019708
Provider Name (Legal Business Name): AMANDA K GOTTSCHALK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DOUGLAS AVE STE 105
ALTAMONTE SPRINGS FL
32714-2058
US

IV. Provider business mailing address

336 BROAD ST STE 203
ROME GA
30161-3006
US

V. Phone/Fax

Practice location:
  • Phone: 407-865-7153
  • Fax: 407-865-7159
Mailing address:
  • Phone: 407-865-7153
  • Fax: 407-865-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT19571
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17203
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT020341
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: