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NPI Code Detail

MEDICARE: AMANDA WALWORTH LPTA

MEDICARE: AMANDA WALWORTH LPTA
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
1225200000XPhysical Therapy Assistant5502005036MI

General Provider Information

NPI Number : 1750061651
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA WALWORTH LPTA
Provider Business Mailing Address
First Line : 4498 OLD CARRIAGE RD
Second Line :
City : FLINT
State : MI
Zip : 48507-5622
Country : US
Telephone Number : 810-965-8997
Fax Number :
Provider Business Practice Location Address
First Line : 9317 VIENNA RD
Second Line :
City : MONTROSE
State : MI
Zip : 48457-9729
Country : US
Telephone Number : 810-639-6171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2023
Last Update Date : 07/25/2023

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