Provider Demographics
NPI:1275658403
Name:IVORY, AMY LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:IVORY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:800 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1660
Practice Address - Country:US
Practice Address - Phone:215-257-3900
Practice Address - Fax:215-257-7545
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1413226OtherHIGHMARK BLUE SHIELD
PA1413226OtherHIGHMARK BLUE SHIELD