Provider Demographics
NPI:1104220615
Name:AMPLIFY REHABILITATION PT OT SLP PLLC
Entity Type:Organization
Organization Name:AMPLIFY REHABILITATION PT OT SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:315-918-5011
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NY
Mailing Address - Zip Code:13634-0186
Mailing Address - Country:US
Mailing Address - Phone:315-918-5011
Mailing Address - Fax:315-918-5027
Practice Address - Street 1:133 CANAL ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NY
Practice Address - Zip Code:13634
Practice Address - Country:US
Practice Address - Phone:315-918-5011
Practice Address - Fax:315-918-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty