Provider Demographics
NPI:1184207201
Name:HUSSEY, AMY JEAN (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:HUSSEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 SW SHEVLIN HIXON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3185
Mailing Address - Country:US
Mailing Address - Phone:541-312-2252
Mailing Address - Fax:541-312-8822
Practice Address - Street 1:147 SW SHEVLIN HIXON DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3185
Practice Address - Country:US
Practice Address - Phone:541-312-2252
Practice Address - Fax:541-312-8822
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4011OtherPT LICENSE