MEDICARE: MRS. AMANDA J TVEDT DPT

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	225100000X	Physical Therapist	LPT-007670	AZ
2	225100000X	Physical Therapist	PT29677	CA

General Provider Information

NPI Number	:	1194753822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA J TVEDT DPT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	5956 E PIMA ST STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-4375
Country	:	US
Telephone Number	:	520-885-4636
Fax Number	:	520-885-4736

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/09/2024

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