Provider Demographics
NPI:1174771919
Name:BACKLUND, AMANDA BETH (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:BACKLUND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10605 DOUBLE R BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521
Mailing Address - Country:US
Mailing Address - Phone:775-853-7475
Mailing Address - Fax:775-853-2013
Practice Address - Street 1:415 HWY 95A SOUTH
Practice Address - Street 2:SUITE C302
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408
Practice Address - Country:US
Practice Address - Phone:775-575-1818
Practice Address - Fax:775-575-1808
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV2236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist