Provider Demographics
NPI:1033558051
Name:ERTLE, AMY MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ERTLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 RIVERVIEW RD
Mailing Address - Street 2:10
Mailing Address - City:PENINSULA
Mailing Address - State:OH
Mailing Address - Zip Code:44264-9637
Mailing Address - Country:US
Mailing Address - Phone:330-322-8843
Mailing Address - Fax:
Practice Address - Street 1:2250 BROAD BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1412
Practice Address - Country:US
Practice Address - Phone:330-322-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020998-E-G225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist