Healthcare Provider Details

I. General information

NPI: 1790651099
Provider Name (Legal Business Name): AMANDA INTERIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 70TH AVE STE A
PLANTATION FL
33317-2349
US

IV. Provider business mailing address

350 NW 70TH AVE STE A
PLANTATION FL
33317-2349
US

V. Phone/Fax

Practice location:
  • Phone: 954-741-2221
  • Fax: 954-741-2155
Mailing address:
  • Phone: 954-741-2221
  • Fax: 954-741-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: