=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376809012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY LEA HUGHES PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2012
-----------------------------------------------------
Last Update Date | 04/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 E 3RD ST
-----------------------------------------------------
City | LIBBY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59923-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-293-3032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4677 GRANITE LAKE RD
-----------------------------------------------------
City | LIBBY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59923-9231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-293-9780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1082
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------