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NPI Code Detail

MEDICARE: AMY BETH WHALEN PT

MEDICARE: AMY BETH WHALEN 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
1225100000XPhysical Therapist5166SC
2225100000XPhysical TherapistP10220NC

General Provider Information

NPI Number : 1679942205
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY BETH WHALEN PT
Provider Business Mailing Address
First Line : 3208 RINGTAIL DR
Second Line :
City : WAXHAW
State : NC
Zip : 28173-7266
Country : US
Telephone Number : 704-776-3111
Fax Number :
Provider Business Practice Location Address
First Line : 8919 PARK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-9600
Country : US
Telephone Number : 704-776-3111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2015
Last Update Date : 03/19/2026

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