Healthcare Provider Details

I. General information

NPI: 1205340528
Provider Name (Legal Business Name): AMY K. W. HEVENER PT, DPT, FMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY K. WHATLEY PT, DPT, FMSC

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 BEECH AVE
BUENA VISTA VA
24416-3101
US

IV. Provider business mailing address

PO BOX 69030
BALTIMORE MD
21264-9030
US

V. Phone/Fax

Practice location:
  • Phone: 540-466-1000
  • Fax:
Mailing address:
  • Phone: 757-873-2302
  • Fax: 757-873-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211632
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: