Healthcare Provider Details

I. General information

NPI: 1679507578
Provider Name (Legal Business Name): AMY CANTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GREY RD
PELZER SC
29669-9222
US

IV. Provider business mailing address

PO BOX 369
SIMPSONVILLE SC
29681-0369
US

V. Phone/Fax

Practice location:
  • Phone: 864-243-5103
  • Fax: 678-840-2112
Mailing address:
  • Phone: 864-201-4301
  • Fax: 678-840-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1543
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: