Healthcare Provider Details

I. General information

NPI: 1679081392
Provider Name (Legal Business Name): AMY FICK DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LEE DPT, PT

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 CAIN RD
FAYETTEVILLE NC
28303-3078
US

IV. Provider business mailing address

4602 CUMBERLAND RD
FAYETTEVILLE NC
28306-2412
US

V. Phone/Fax

Practice location:
  • Phone: 910-423-5622
  • Fax: 910-378-1755
Mailing address:
  • Phone: 910-423-5622
  • Fax: 910-378-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20751
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: