Healthcare Provider Details

I. General information

NPI: 1992681191
Provider Name (Legal Business Name): AMANDA ROSE SUDLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7491 N FEDERAL HWY STE C16-17
BOCA RATON FL
33487-1625
US

IV. Provider business mailing address

891 NW 85TH TER APT 1501
PLANTATION FL
33324-1253
US

V. Phone/Fax

Practice location:
  • Phone: 561-450-6487
  • Fax:
Mailing address:
  • Phone: 954-218-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA34233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: