Healthcare Provider Details

I. General information

NPI: 1841475027
Provider Name (Legal Business Name): AMANDA CLEMENTZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7938 GA HIGHWAY 21 STE 300
PORT WENTWORTH GA
31407-9808
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 912-965-0601
  • Fax:
Mailing address:
  • Phone: 423-238-8923
  • Fax: 309-672-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016003
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070013744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: