Provider Demographics
NPI:1184179897
Name:VIETOR, AMY (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:VIETOR
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BRITTON
Mailing Address - State:SD
Mailing Address - Zip Code:57430-2274
Mailing Address - Country:US
Mailing Address - Phone:605-448-1118
Mailing Address - Fax:605-448-1140
Practice Address - Street 1:413 9TH ST
Practice Address - Street 2:
Practice Address - City:BRITTON
Practice Address - State:SD
Practice Address - Zip Code:57430-2274
Practice Address - Country:US
Practice Address - Phone:605-448-1118
Practice Address - Fax:605-448-1140
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist