Provider Demographics
NPI:1932064458
Name:MAALOUF, AMANDA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MAALOUF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 WILSHIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1221
Mailing Address - Country:US
Mailing Address - Phone:310-477-7774
Mailing Address - Fax:
Practice Address - Street 1:12121 WILSHIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1221
Practice Address - Country:US
Practice Address - Phone:310-477-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-17
Last Update Date:2025-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty