Individual ProviderAmanda M NolanPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address16815 S Desert Foothills Pkwy, Phoenix, AZ 85048-8401(480) 704-5954(740) 739-3896PECOS EnrollmentBased on the most recent information from CMS, provider Amanda M Nolan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1811427149Provider TypeIndividualFull NameNolan, Amanda MCredentialPTGenderFemaleSole ProprietorNoEnumeration Date6/19/2017Last Updated7/22/2020Contact InformationPractice LocationPractice Address16815 S Desert Foothills Pkwy, Phoenix, AZ 85048-8401Phone(480) 704-5954FaxUnlisted FaxMailing LocationMailing Address1673 N Marketside Ave, Buckeye, AZ 85396-2036Phone(740) 739-3896FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseLPT-013118Code225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicensePT016941Ohio