Healthcare Provider Details

I. General information

NPI: 1619152980
Provider Name (Legal Business Name): AMY S KINSEY P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W ELM AVE
MONROE MI
48162-7909
US

IV. Provider business mailing address

9993 CEMETERY RD
ERIE MI
48133-9731
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-9670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: