MEDICARE: AMANDA NOTLEY-KIM 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	039663	NY

General Provider Information

NPI Number	:	1588022982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NOTLEY-KIM PT

Provider Business Mailing Address
First Line	:	PO BOX 493
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-0493
Country	:	US
Telephone Number	:	845-675-8444
Fax Number	:	845-675-0333

Provider Business Practice Location Address
First Line	:	15 LAKE RIDGE PLZ
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-1925
Country	:	US
Telephone Number	:	845-675-8444
Fax Number	:	845-675-0333

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

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	04/20/2023

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