Provider Demographics
NPI:1295010049
Name:FERRARI, AMY CAROL (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CAROL
Last Name:FERRARI
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 1:5874 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9222
Mailing Address - Country:US
Mailing Address - Phone:716-731-3694
Mailing Address - Fax:
Practice Address - Street 1:4124 SAUNDERS SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:SANBORN
Practice Address - State:NY
Practice Address - Zip Code:14132-9523
Practice Address - Country:US
Practice Address - Phone:180-083-6751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012098174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012098OtherNYS PT LICENSE #