Agbannawag, Amanda Maryam

Agbannawag, Amanda Maryam is an individual health care provider with primary practice located at 3988 E Fort Lowell Rd , Tucson AZ 85712-1010. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Agbannawag, Amanda Maryam can be contacted via phone (520) 488-5291.

Contact Information

Primary practice address
3988 E Fort Lowell Rd Tucson AZ 85712-1010
Phone: (520) 488-5291
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X LPT-30412 Arizona

Profile Details

NPI number 1255805727
LBN Legal business name Agbannawag, Amanda Maryam
Credentials DPT
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2019
Last updated Jul 14th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255805727 NPPES
Arizona MEDICAID 568098

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