MEDICARE: MS. AMY HELEN AMABILE MPT

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	225100000X	Physical Therapist	3058	NM
2	225100000X	Physical Therapist	029162-1	NY
3	225100000X	Physical Therapist	1172446	TX
4	225100000X	Physical Therapist	PT020450	PA

General Provider Information

NPI Number	:	1407033368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY HELEN AMABILE MPT

Provider Business Mailing Address
First Line	:	2521 N MAIN ST
Second Line	:	#1-224
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1154
Country	:	US
Telephone Number	:	575-496-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	2521 N MAIN ST
Second Line	:	#1-224
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1154
Country	:	US
Telephone Number	:	575-496-0801
Fax Number	:

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	11/08/2010

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