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NPI Code Detail

MEDICARE: AMANDA PILLIS MONTALTO MPT

MEDICARE: AMANDA PILLIS MONTALTO MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305203031VA

General Provider Information

NPI Number : 1619062767
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA PILLIS MONTALTO MPT
Provider Business Mailing Address
First Line : 1903 CORNELL AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23226-3512
Country : US
Telephone Number : 804-673-6945
Fax Number :
Provider Business Practice Location Address
First Line : 2924 BROOK RD
Second Line :
City : RICHMOND
State : VA
Zip : 23220-1215
Country : US
Telephone Number : 804-321-7474
Fax Number : 804-228-5991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ AMANDA PILLIS MONTALTO MPT” Practice Location

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