Provider Demographics
NPI:1417588526
Name:LINDBERG, AMELIA ROGERS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ROGERS
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 79TH ST APT 124S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6246
Mailing Address - Country:US
Mailing Address - Phone:917-765-0970
Mailing Address - Fax:
Practice Address - Street 1:230 WEST 79TH STREET
Practice Address - Street 2:APT 124S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:440-479-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist