Healthcare Provider Details

I. General information

NPI: 1609737105
Provider Name (Legal Business Name): AMANDA HART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 E BOXELDER RD STE 100
GILLETTE WY
82718-5936
US

IV. Provider business mailing address

8 CONSTITUTION DR
GILLETTE WY
82716-1810
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0947
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: