Provider Demographics
NPI:1184847675
Name:FOREMAN, AMY J (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1427
Mailing Address - Country:US
Mailing Address - Phone:717-593-0264
Mailing Address - Fax:
Practice Address - Street 1:1183 LUTHER DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7407
Practice Address - Country:US
Practice Address - Phone:301-790-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant