MEDICARE: AMANDA HARTLEY 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1154722122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HARTLEY DPT

Provider Business Mailing Address
First Line	:	2929 DESERT STORM DR
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-9114
Country	:	US
Telephone Number	:	910-806-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 DESERT STORM DR
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-9114
Country	:	US
Telephone Number	:	910-806-3358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	01/06/2025

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