MEDICARE: MISS AMANDA ELIZABETH WEST MPT

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

General Provider Information

NPI Number	:	1831399187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA ELIZABETH WEST MPT

Provider Business Mailing Address
First Line	:	136 BRITTANY LN
Second Line	:
City	:	BONNEAU
State	:	SC
Zip	:	29431-8731
Country	:	US
Telephone Number	:	843-860-0856
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 BAKER HOSPITAL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-8233
Country	:	US
Telephone Number	:	843-744-2750
Fax Number	:

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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