MEDICARE: AMY VOORHIS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2306603922	VA

General Provider Information

NPI Number	:	1073920195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY VOORHIS PTA

Provider Business Mailing Address
First Line	:	22 FAIRFAX ST SE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-3616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 FAIRFAX ST SE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-3616
Country	:	US
Telephone Number	:	703-669-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	07/21/2014

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