Healthcare Provider Details

I. General information

NPI: 1619221991
Provider Name (Legal Business Name): AMANDA PETTY PT, DPT, NCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MENDES PT

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 10/11/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 W HORIZON RIDGE PKWY STE 320
HENDERSON NV
89052-4395
US

IV. Provider business mailing address

874 AMERICAN PACIFIC DR
HENDERSON NV
89014-8800
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-4116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6557
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number6557
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: