Active NPI
Amanda N Petter, PT
- Physical Therapist
- Georgetown, TX
National Provider Identifier
1215040290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1134153
- Practice address
- 204 S Ih 35
Ste 203
Georgetown, TX 78628-4126 - Phone
- (512) 863-7761
- Fax
- (512) 863-0973
- NPI assigned
- Aug 16, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1134153 | TX | Primary |
Addresses
Primary practice location
204 S Ih 35
Ste 203
Georgetown, TX 78628-4126
Mailing address
204 S Ih 35
Ste 203
Georgetown, TX 78628-4126
Phone (512) 863-7761
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7268629 | Other | TX | AETNA HEALTHCARE |
| 2274981 | Other | TX | FIRST HEALTH |
Other names 1
- Miss Amanda N Fontenot
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1134153 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Physical Therapy Specialists | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Georgetown, TX
- NPI 1467448522
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215040290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 S IH 35",
"address_2": "STE 203",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786284126",
"telephone_number": "512-863-7761",
"fax_number": "512-863-0973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 S IH 35",
"address_2": "STE 203",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786284126",
"telephone_number": "512-863-7761",
"fax_number": "512-863-0973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTER",
"first_name": "AMANDA",
"middle_name": "N",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1134153",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HEALTHCARE",
"identifier": "7268629",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "2274981",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "FONTENOT",
"middle_name": "N",
"prefix": "MISS",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.