MEDICARE: DR. AMY VITALE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501019935	MI

General Provider Information

NPI Number	:	1053904912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY VITALE DPT

Provider Business Mailing Address
First Line	:	22809 FRANCIS ST
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48082-1795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 KERCHEVAL AVE
Second Line	:
City	:	GROSSE POINTE FARMS
State	:	MI
Zip	:	48236-3610
Country	:	US
Telephone Number	:	313-640-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	05/07/2026

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