Healthcare Provider Details

I. General information

NPI: 1598026726
Provider Name (Legal Business Name): AMY WEBSTER HEALY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 04/12/2022
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST STE 214
LEBANON NH
03766-6309
US

IV. Provider business mailing address

20 W PARK ST STE 214 BOX 423
LEBANON NH
03766-6309
US

V. Phone/Fax

Practice location:
  • Phone: 802-755-5678
  • Fax: 888-853-6970
Mailing address:
  • Phone: 802-755-5678
  • Fax: 888-853-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number189604
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3498
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: