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General NPI Number Information
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NPI Number | 1023597085
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Entity Type | Individual
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Provider Name | AMANDA GILLHAM
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Gender | Female
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 1400 BLACK HILL DR
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City | GAINESVILLE
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State | TX
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Zip | 76240-4625
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Country | US
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Telephone | 940-665-5221
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Fax |
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Provider Business Mailing Address
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Address Line | 16263 SNAKEWOOD RD
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City | MARIETTA
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State | OK
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Zip | 73448-7317
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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