Healthcare Provider Details

I. General information

NPI: 1598922213
Provider Name (Legal Business Name): AMY LYNN GURNEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HIGHLAND AVE
WATERVILLE ME
04901-5309
US

IV. Provider business mailing address

27 CUMBERLAND ST APT 2
AUGUSTA ME
04330-4016
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-0705
  • Fax:
Mailing address:
  • Phone: 207-649-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA1742
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: