Healthcare Provider Details

I. General information

NPI: 1982816252
Provider Name (Legal Business Name): AMY M HUMPHREY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EDEN RD
LANCASTER PA
17601-4700
US

IV. Provider business mailing address

160 N POINTE BLVD STE 113
LANCASTER PA
17601-4134
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-4184
  • Fax: 717-569-4192
Mailing address:
  • Phone: 717-569-4184
  • Fax: 717-569-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305203293
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: