MEDICARE: AMY M THARP 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	21038	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336180645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M THARP PT

Provider Business Mailing Address
First Line	:	4223 LIRON AVE
Second Line	:	# 204
City	:	FORT MYERS
State	:	FL
Zip	:	33916-7859
Country	:	US
Telephone Number	:	239-481-0761
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 LIRON AVE
Second Line	:	# 204
City	:	FORT MYERS
State	:	FL
Zip	:	33916-7859
Country	:	US
Telephone Number	:	239-481-0761
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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Directions to “ AMY M THARP PT” Practice Location

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