MEDICARE: MS. AMANDA CRYSTAL VIZI D.P.T.

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	12206	NC
2	225100000X	Physical Therapist	PT.014605	OH

General Provider Information

NPI Number	:	1245527647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA CRYSTAL VIZI D.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 601791
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1791
Country	:	US
Telephone Number	:	704-316-3104
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 GILLMAN RD STE 200B
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-7922
Country	:	US
Telephone Number	:	704-316-3104
Fax Number	:	704-316-3105

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

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	05/22/2026

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