Provider Demographics
NPI:1023199080
Name:PHILLIPS, AMBER MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:3652 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-6544
Practice Address - Country:US
Practice Address - Phone:814-736-9600
Practice Address - Fax:814-266-3407
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001595295OtherHIGHMARK BLUE SHIELD
PA7289698OtherAETNA
PA237489OtherHEALTH AMER/HEALTH ASSUR.
PA396749Medicare ID - Type UnspecifiedMEDICARE