Provider Demographics
NPI:1114623741
Name:THOMAS, AMY T
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 S DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4705
Mailing Address - Country:US
Mailing Address - Phone:317-372-3866
Mailing Address - Fax:
Practice Address - Street 1:46175 WESTLAKE DR STE 410
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5886
Practice Address - Country:US
Practice Address - Phone:703-951-6409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program