Provider Demographics
NPI:1235350083
Name:ANSON, AMBER O'NEAL (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:O'NEAL
Last Name:ANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:O'NEAL
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:700 LAC DE VILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5665
Mailing Address - Country:US
Mailing Address - Phone:585-385-6287
Mailing Address - Fax:585-427-7410
Practice Address - Street 1:700 LAC DE VILLE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5665
Practice Address - Country:US
Practice Address - Phone:585-385-6287
Practice Address - Fax:585-383-0033
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870726225100000X
MD22409225100000X
NY042356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist