Healthcare Provider Details

I. General information

NPI: 1033463716
Provider Name (Legal Business Name): AMBER FLEMING PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 SPICER DR SE
ALBANY OR
97322-7043
US

IV. Provider business mailing address

3615 SPICER DR SE
ALBANY OR
97322-7043
US

V. Phone/Fax

Practice location:
  • Phone: 541-967-7551
  • Fax:
Mailing address:
  • Phone: 541-967-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006119
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number61937
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: