Healthcare Provider Details

I. General information

NPI: 1255623724
Provider Name (Legal Business Name): AMANDA LILLIAN OPRON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LAKE HOWELL RD SUITE 1031
MAITLAND FL
32751-5926
US

IV. Provider business mailing address

8552 SUMMERVILLE PLACE
ORLANDO FL
32819
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-0433
  • Fax:
Mailing address:
  • Phone: 407-325-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: