MEDICARE: AMANDA CLEMENTZ PT

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
1	225100000X	Physical Therapist	PT016003	GA
2	225100000X	Physical Therapist	070013744	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01141585	OTHER	IL	RR MEDICARE

General Provider Information

NPI Number	:	1841475027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CLEMENTZ PT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-238-8923
Fax Number	:	309-672-4569

Provider Business Practice Location Address
First Line	:	7938 GA HIGHWAY 21 STE 300
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9808
Country	:	US
Telephone Number	:	912-965-0601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	09/08/2022

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Directions to “ AMANDA CLEMENTZ PT” Practice Location

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