Basic Information
| Provider Information | |||||||||
| NPI: | 1710150727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STODDARD | ||||||||
| FirstName: | AMIE | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8940 | ||||||||
| Address2: | UNR SPORTS MEDICINE COMPLEX | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895078940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757841999 | ||||||||
| FaxNumber: | 7757841995 | ||||||||
| Practice Location | |||||||||
| Address1: | 1664 N VIRGINIA ST, | ||||||||
| Address2: | UNR CAMPUS UNR SPORTS MEDICINE COMPLEX | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757841999 | ||||||||
| FaxNumber: | 7757841995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2203 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.