Provider Demographics
NPI:1326011594
Name:BOYER, AMY C (MPT, MAED, ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:BOYER
Suffix:
Gender:F
Credentials:MPT, MAED, ATC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:NICKLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7405
Mailing Address - Country:US
Mailing Address - Phone:434-817-7848
Mailing Address - Fax:434-465-6834
Practice Address - Street 1:111 MONTICELLO AVE STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5698
Practice Address - Country:US
Practice Address - Phone:434-817-4276
Practice Address - Fax:434-465-6836
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010147620Medicaid
VAP00258650OtherMEDICARE PIN
VA175787OtherANTHEM SERVICES
VA3123773OtherMAMSI
VA3123773OtherMAMSI
VA010147620Medicaid