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General NPI Number Information
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NPI Number | 1649647314
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Entity Type | Individual
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Provider Name | AMY ELIZABETH BANGHART PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 811 W MAIN ST STE 205
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City | LEXINGTON
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State | SC
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Zip | 29072-2500
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Country | US
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Telephone | 803-358-6115
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6069
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City | WEST COLUMBIA
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State | SC
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Zip | 29171-6069
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Country | US
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Telephone | 803-791-2203
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000031836
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11291
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License Number State | SC
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