Healthcare Provider Details

I. General information

NPI: 1184672420
Provider Name (Legal Business Name): AMIE ASHLEY PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VANDERBILT AVE SUITE 1413
NEW YORK NY
10017-3808
US

IV. Provider business mailing address

30 WALL ST 4TH FLOOR
NEW YORK NY
10005-2201
US

V. Phone/Fax

Practice location:
  • Phone: 212-599-0099
  • Fax: 212-599-0389
Mailing address:
  • Phone: 212-514-6499
  • Fax: 212-514-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23724
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: