Healthcare Provider Details

I. General information

NPI: 1023040508
Provider Name (Legal Business Name): AMY DORE D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 FOREST AVENUE SUITE #2
PACIFIC GROVE CA
93950-5100
US

IV. Provider business mailing address

1199 FOREST AVE SUITE #2
PACIFIC GROVE CA
93950-5100
US

V. Phone/Fax

Practice location:
  • Phone: 831-643-9643
  • Fax: 831-643-9653
Mailing address:
  • Phone: 831-643-9643
  • Fax: 831-643-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: