Provider Demographics
NPI:1477595700
Name:LANKFORD, AMBER LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:LANKFORD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SOUTH BROAD STREET
Mailing Address - Street 2:STE 2
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115
Mailing Address - Country:US
Mailing Address - Phone:704-660-6551
Mailing Address - Fax:704-660-9894
Practice Address - Street 1:124 PROFESSIONAL PARK DR
Practice Address - Street 2:STE C
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-658-1095
Practice Address - Fax:704-658-1097
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
079P4OtherBCBS