Provider Demographics
NPI:1215220686
Name:BAMFORD, AMY E (PT, DPT, CLT, CWS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:PT, DPT, CLT, CWS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:BORG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT, CWS
Mailing Address - Street 1:PSC 41 BOX 4952
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464-0050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 41 BOX 4952
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464-0050
Practice Address - Country:US
Practice Address - Phone:0128-481-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162842225100000X
WAPT60309878225100000X
ZZPH100725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist