MEDICARE: AMY FEE PHYSICAL THERAPY INC

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	7030	CO
2	225100000X	Physical Therapist	27397	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ08333Z	OTHER		BLUE SHIELD
2	0007251525	OTHER		AETNA

General Provider Information

NPI Number	:	1184733818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY FEE PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	3435 OCEAN PARK BLVD STE 111
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3318
Country	:	US
Telephone Number	:	310-393-1703
Fax Number	:	310-943-0462

Provider Business Practice Location Address
First Line	:	3435 OCEAN PARK BLVD STE 111
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3318
Country	:	US
Telephone Number	:	310-393-1703
Fax Number	:	310-943-0462

Authorized Official
Title or Position	:	OWNER PHYSICAL THERAPIST
Name	:	AMY BROOKE FEE
Credential	:	DPT MPT ATC CSCS
Telephone Number	:	310-393-1703

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/26/2024

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