Provider Demographics
NPI:1477707198
Name:WALTER, AMY J (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:WALTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3085 HARLEM ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5000
Mailing Address - Fax:716-844-5050
Practice Address - Street 1:3085 HARLEM ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030475-NG225100000X
NY030475-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477707198OtherUNIVERA
NY9315468OtherINDEPENDENT HEALTH
NY11303OtherAETNA/MAGNCARE
NY000531015001OtherBLUE CROSS WNY
NY1053747OtherGHI
NY1477707198OtherNOVA
NY9315468OtherINDEPENDENT HEALTH