MEDICARE: MRS. AMY MARIA MENKER PT

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	07671	OH

General Provider Information

NPI Number	:	1306071287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MARIA MENKER PT

Provider Business Mailing Address
First Line	:	99 CAUSEWAY DR
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-9523
Country	:	US
Telephone Number	:	419-394-1908
Fax Number	:	419-394-0883

Provider Business Practice Location Address
First Line	:	99 CAUSEWAY DR
Second Line	:
City	:	SAINT MARYS
State	:	OH
Zip	:	45885-9523
Country	:	US
Telephone Number	:	419-394-1908
Fax Number	:	419-394-0883

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

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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