Provider Demographics
NPI:1063498467
Name:RADKOWSKI, AMY J (MPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:RADKOWSKI
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 1:495 WATERFRONT DR E
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1140
Mailing Address - Country:US
Mailing Address - Phone:412-325-2110
Mailing Address - Fax:412-325-2113
Practice Address - Street 1:495 WATERFRONT DR E
Practice Address - Street 2:SUITE 240
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1140
Practice Address - Country:US
Practice Address - Phone:412-325-2110
Practice Address - Fax:412-325-2113
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504966Medicare ID - Type Unspecified