Provider Demographics
NPI:1376927376
Name:HESBACH, AMIE L (PT)
Entity Type:Individual
Prefix:DR
First Name:AMIE
Middle Name:L
Last Name:HESBACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:L
Other - Last Name:HESBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-1704
Mailing Address - Country:US
Mailing Address - Phone:410-474-8309
Mailing Address - Fax:
Practice Address - Street 1:2 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-1704
Practice Address - Country:US
Practice Address - Phone:410-474-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist