Healthcare Provider Details

I. General information

NPI: 1245527647
Provider Name (Legal Business Name): AMANDA CRYSTAL VIZI D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 GILLMAN RD STE 200B
DENVER NC
28037-7922
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-3104
  • Fax: 704-316-3105
Mailing address:
  • Phone: 704-316-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12206
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.014605
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: