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NPI Code Detail

MEDICARE: MR. MICHAEL PAUL AMY PHYSICAL THERAPIST

MEDICARE: MR. MICHAEL PAUL AMY PHYSICAL THERAPIST
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
12251P0200XPediatric Physical Therapist020396-1NY

General Provider Information

NPI Number : 1417926288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL PAUL AMY PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 28 GRAVES ST
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1206
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 131 W BROAD ST
Second Line : ROCHESTER CITY SCHOOL DISTRICT
City : ROCHESTER
State : NY
Zip : 14614-1103
Country : US
Telephone Number : 585-328-8228
Fax Number : 585-464-6196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2006
Last Update Date : 07/08/2007

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