Provider Demographics
NPI:1386815405
Name:SPEZIA, AMY COLLEEN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:COLLEEN
Last Name:SPEZIA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:COLLEEN
Other - Last Name:MOHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3347 TIMBER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506
Mailing Address - Country:US
Mailing Address - Phone:314-591-1794
Mailing Address - Fax:314-567-4505
Practice Address - Street 1:1683 S. JEFFERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506
Practice Address - Country:US
Practice Address - Phone:931-372-7529
Practice Address - Fax:314-567-4505
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007032189225100000X
TN9889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist