Healthcare Provider Details

I. General information

NPI: 1487177580
Provider Name (Legal Business Name): AMY BRAMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LONDON MOUNTAIN VIEW DR STE 400
LONDON KY
40741-6669
US

IV. Provider business mailing address

PO BOX 441146
KENNESAW GA
30160-9522
US

V. Phone/Fax

Practice location:
  • Phone: 678-403-3632
  • Fax: 678-567-6737
Mailing address:
  • Phone: 678-403-3632
  • Fax:

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: