Healthcare Provider Details

I. General information

NPI: 1871222844
Provider Name (Legal Business Name): AMANDA ROSE SIMMONS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ROSE WESTLAKE PT, DPT

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 E MISSION AVE STE D
SPOKANE VALLEY WA
99206-4832
US

IV. Provider business mailing address

1509 W ALICE AVE
SPOKANE WA
99205-2713
US

V. Phone/Fax

Practice location:
  • Phone: 509-720-7077
  • Fax: 509-219-0396
Mailing address:
  • Phone: 509-263-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: