Provider Demographics
NPI:1043551625
Name:PARKER, AMY ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:PARKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 LOVEMAN RD
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2515
Mailing Address - Country:US
Mailing Address - Phone:609-947-3698
Mailing Address - Fax:609-372-4519
Practice Address - Street 1:57 LOVEMAN RD
Practice Address - Street 2:
Practice Address - City:CREAM RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08514-2515
Practice Address - Country:US
Practice Address - Phone:609-947-3698
Practice Address - Fax:609-372-4519
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00905300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00905300OtherSTATE OF NEW JERSEY LICENSE