Provider Demographics
NPI:1750029625
Name:ENNETT, AMANDA JEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:ENNETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:CO
Mailing Address - Zip Code:80470-7951
Mailing Address - Country:US
Mailing Address - Phone:925-784-4528
Mailing Address - Fax:
Practice Address - Street 1:25577 CONIFER RD UNIT 125
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9068
Practice Address - Country:US
Practice Address - Phone:303-838-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
COPTL.0018501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist