Healthcare Provider Details

I. General information

NPI: 1144976036
Provider Name (Legal Business Name): AMBER D POYTHRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 E CANAL DR STE 1
TURLOCK CA
95380-4542
US

IV. Provider business mailing address

875 E CANAL DR STE 1
TURLOCK CA
95380-4542
US

V. Phone/Fax

Practice location:
  • Phone: 209-633-3077
  • Fax: 209-633-3078
Mailing address:
  • Phone: 209-633-3077
  • Fax: 209-633-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: