Active NPI
Amanda Tilton Martin, PT
- Physical Therapist
- Stowe, VT
National Provider Identifier
1477620250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 040-0003034
- Practice address
- 56 Old Farm Rd
Stowe, VT 05672-4434 - Phone
- (802) 253-6852
- NPI assigned
- Nov 29, 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 | 040-0003034 | VT | Primary |
Addresses
Primary practice location
56 Old Farm Rd
Stowe, VT 05672-4434
Mailing address
3251 VT Route 109
Waterville, VT 05492-9518
Phone (802) 644-6364
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1009723 | Medicaid | VT |
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 |
|---|---|---|---|
| 040-0003034 | VT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Personalized PT, PC | Physical Therapist | 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.
-
- Physical Therapist
- Morrisville, VT
- NPI 1851463434
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477620250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3251 VT ROUTE 109",
"city": "WATERVILLE",
"state": "VT",
"postal_code": "054929518",
"telephone_number": "802-644-6364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56 OLD FARM RD",
"city": "STOWE",
"state": "VT",
"postal_code": "056724434",
"telephone_number": "802-253-6852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILTON MARTIN",
"first_name": "AMANDA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VT",
"license": "040-0003034",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1009723",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stowe, VT
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.