Provider Demographics
NPI:1063473080
Name:CHILDS, AMY REBECCA (BSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:REBECCA
Last Name:CHILDS
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:REBECCA
Other - Last Name:CRETIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSPT
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:4886 PORT ROYAL RD
Practice Address - Street 2:STE. 180
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2975
Practice Address - Country:US
Practice Address - Phone:931-499-7350
Practice Address - Fax:931-499-7351
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650115Medicaid
TN3650115Medicare PIN