Provider Demographics
NPI:1003042292
Name:CHILTON, AMANDA GAYLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GAYLE
Last Name:CHILTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3842
Mailing Address - Country:US
Mailing Address - Phone:479-782-1444
Mailing Address - Fax:479-782-1477
Practice Address - Street 1:311 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3842
Practice Address - Country:US
Practice Address - Phone:479-782-1444
Practice Address - Fax:479-782-1477
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2419225100000X
ARPT 2419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT 2419OtherSTATE OF ARKANSAS PHYSICAL THERAPIST LICENSE
MI5501011148OtherSTATE OF MICHIGAN PHYSICAL THERAPIST LICENSE