Provider Demographics
NPI:1528511284
Name:WARGO, AMANDA (DPT, PCS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WARGO
Suffix:
Gender:F
Credentials:DPT, PCS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KELLEY
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PCS
Mailing Address - Street 1:24 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04222-5464
Mailing Address - Country:US
Mailing Address - Phone:203-841-8885
Mailing Address - Fax:
Practice Address - Street 1:41 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1285
Practice Address - Country:US
Practice Address - Phone:207-844-8287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11047225100000X
MEPT5412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist