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NPI Code Detail

MEDICARE: AMANDA R KESTERSON DPT

MEDICARE: AMANDA R KESTERSON DPT
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 Therapist9615TN

General Provider Information

NPI Number : 1104266550
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA R KESTERSON DPT
Provider Business Mailing Address
First Line : 8823 PRODUCTION LN
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-6511
Country : US
Telephone Number : 423-238-8923
Fax Number : 423-954-7399
Provider Business Practice Location Address
First Line : 275 JACKSON MEADOWS DR STE 101
Second Line :
City : HERMITAGE
State : TN
Zip : 37076-1454
Country : US
Telephone Number : 615-885-7848
Fax Number : 615-885-8292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2013
Last Update Date : 04/13/2017

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Directions to “ AMANDA R KESTERSON DPT” Practice Location

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