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NPI Code Detail

MEDICARE: MRS. AMANDA GAYLE CHILTON PT

MEDICARE: MRS. AMANDA GAYLE CHILTON PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2419AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT 2419OTHERARSTATE OF ARKANSAS PHYSICAL THERAPIST LICENSE
25501011148OTHERMISTATE OF MICHIGAN PHYSICAL THERAPIST LICENSE

General Provider Information

NPI Number : 1003042292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA GAYLE CHILTON PT
Provider Business Mailing Address
First Line : 311 LEXINGTON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-3842
Country : US
Telephone Number : 479-782-1444
Fax Number : 479-782-1477
Provider Business Practice Location Address
First Line : 311 LEXINGTON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-3842
Country : US
Telephone Number : 479-782-1444
Fax Number : 479-782-1477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2009
Last Update Date : 03/14/2023

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