Healthcare Provider Details

I. General information

NPI: 1386076818
Provider Name (Legal Business Name): AMANDA LYN MILANAK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH SC
29588-7252
US

IV. Provider business mailing address

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH SC
29588-7252
US

V. Phone/Fax

Practice location:
  • Phone: 843-293-5610
  • Fax:
Mailing address:
  • Phone: 843-293-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP030750T
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8536
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: