MEDICARE: AMANDA ANN PHILLIPS 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1164500344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ANN PHILLIPS PT

Provider Business Mailing Address
First Line	:	18214 WINDWARD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-1755
Country	:	US
Telephone Number	:	216-531-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	35010 CHARDON RD
Second Line	:	STE 100
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-9010
Country	:	US
Telephone Number	:	440-951-1910
Fax Number	:	440-951-1940

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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