Provider Demographics
NPI:1114350683
Name:GREMILLION, AMY M (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:GREMILLION
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:LOVELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 BERING DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2130
Mailing Address - Country:US
Mailing Address - Phone:832-494-2200
Mailing Address - Fax:281-768-4610
Practice Address - Street 1:800 BERING DR STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2130
Practice Address - Country:US
Practice Address - Phone:832-494-2200
Practice Address - Fax:281-768-4610
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1231929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1231929OtherLICENSE NUMBER