Provider Demographics
NPI:1992681191
Name:SUDLER, AMANDA ROSE (PTA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:SUDLER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 NW 85TH TER APT 1501
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1253
Mailing Address - Country:US
Mailing Address - Phone:954-218-6494
Mailing Address - Fax:
Practice Address - Street 1:7491 N FEDERAL HWY STE C16-17
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1625
Practice Address - Country:US
Practice Address - Phone:561-450-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA34233225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant