Provider Demographics
NPI:1366461139
Name:KILGORE, AMANDA M (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:KILGORE
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TAMKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 W NORTHMOOR RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-3542
Mailing Address - Country:US
Mailing Address - Phone:309-692-5337
Mailing Address - Fax:309-693-3913
Practice Address - Street 1:427 W NORTHMOOR RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3542
Practice Address - Country:US
Practice Address - Phone:309-692-5337
Practice Address - Fax:309-693-3913
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist