Provider Demographics
NPI:1518921295
Name:PILZ, AMANDA G (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:G
Last Name:PILZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3917
Mailing Address - Country:US
Mailing Address - Phone:770-554-7977
Mailing Address - Fax:770-554-4177
Practice Address - Street 1:3890 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3917
Practice Address - Country:US
Practice Address - Phone:770-554-7977
Practice Address - Fax:770-554-4177
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4351OtherMEDICARE GRP
GRP PIN 821337OtherBLUE CROSS BLUE SHIELD
GA1386659894OtherPROMOTION PHYSICAL THERAPY FACILITY NPI
GA582654830OtherBLUE CROSS BLUE SHIELD
GRP PIN 821337OtherBLUE CROSS BLUE SHIELD
GA65BBBRGMedicare PIN