Provider Demographics
NPI:1275770448
Name:HARCOURT, AMY BEACH (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BEACH
Last Name:HARCOURT
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 1:5097 98TH WAY N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3646
Mailing Address - Country:US
Mailing Address - Phone:727-560-1080
Mailing Address - Fax:
Practice Address - Street 1:3488 EAST LAKE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685
Practice Address - Country:US
Practice Address - Phone:727-786-1996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist