Provider Demographics
NPI:1063142875
Name:WITHAM, AMELIA KATHRYN (DPT)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:KATHRYN
Last Name:WITHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N EISENHOWER DR APT M3
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-5147
Mailing Address - Country:US
Mailing Address - Phone:319-325-7047
Mailing Address - Fax:
Practice Address - Street 1:2641 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4969
Practice Address - Country:US
Practice Address - Phone:785-438-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist