MEDICARE: AMY SUELLEN APPLEWHITE

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	225200000X	Physical Therapy Assistant	2047124	TX

General Provider Information

NPI Number	:	1700187853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SUELLEN APPLEWHITE

Provider Business Mailing Address
First Line	:	6104 LBJ FWY
Second Line	:	APT# 2602
City	:	DALLAS
State	:	TX
Zip	:	75240-7121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6104 LBJ FWY
Second Line	:	APT# 2602
City	:	DALLAS
State	:	TX
Zip	:	75240-7121
Country	:	US
Telephone Number	:	361-548-7456
Fax Number	:

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

Provider Enumeration Date	:	11/05/2010
Last Update Date	:	11/05/2010

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