Provider Demographics
NPI:1023040508
Name:DORE, AMY (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 FOREST AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5100
Mailing Address - Country:US
Mailing Address - Phone:831-643-9643
Mailing Address - Fax:831-643-9653
Practice Address - Street 1:1199 FOREST AVENUE
Practice Address - Street 2:SUITE #2
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5100
Practice Address - Country:US
Practice Address - Phone:831-643-9643
Practice Address - Fax:831-643-9653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02879ZMedicare ID - Type UnspecifiedPROVIDER #