Provider Demographics
NPI:1235233800
Name:CLOUSER, AMY TRAYLOR (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:TRAYLOR
Last Name:CLOUSER
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 1:626 TRAIL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4934
Mailing Address - Country:US
Mailing Address - Phone:301-662-1997
Mailing Address - Fax:301-668-2202
Practice Address - Street 1:86 THOMAS JOHNSON CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-694-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD167MP235Medicare PIN
MDG00930-020511H30Medicare PIN