Healthcare Provider Details

I. General information

NPI: 1619254950
Provider Name (Legal Business Name): DAMITA WATKINS AMICK MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 W MARKET ST STE B
GREENSBORO NC
27403-4442
US

IV. Provider business mailing address

3511 W MARKET ST STE B
GREENSBORO NC
27403-4442
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-3338
  • Fax: 336-294-6696
Mailing address:
  • Phone: 336-294-3338
  • Fax: 336-294-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number13476
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: