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General NPI Number Information
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NPI Number | 1851467542
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Entity Type | Individual
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Provider Name | AMY LYNN MCCALLUMORE DPT, OMPT
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Gender | Female
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 15979 HALL RD STE 150
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City | MACOMB
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State | MI
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Zip | 48044-5362
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Country | US
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Telephone | 586-416-8439
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Fax | 586-416-8440
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Provider Business Mailing Address
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Address Line | 2181 CUT CRYSTAL LN
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City | SHELBY TWP
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State | MI
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Zip | 48316-2804
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Country | US
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Telephone | 586-219-9560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011655
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License Number State | MI
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