Provider Demographics
NPI:1083138564
Name:BAXTER, AMY (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 ZOLLINGER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-1928
Mailing Address - Country:US
Mailing Address - Phone:513-505-9507
Mailing Address - Fax:
Practice Address - Street 1:4343 ALL SEASONS DR STE 220
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1962
Practice Address - Country:US
Practice Address - Phone:614-544-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist