MEDICARE: AMY MAGOON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA-014445	AZ

General Provider Information

NPI Number	:	1174414080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MAGOON

Provider Business Mailing Address
First Line	:	43463 W SUNLAND DR
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85138-2374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21083 N JOHN WAYNE PKWY
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-2959
Country	:	US
Telephone Number	:	580-233-7555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	07/10/2025

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Directions to “ AMY MAGOON ” Practice Location

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