Provider Demographics
NPI:1497959035
Name:PLATT, AMY (PT, RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PLATT
Suffix:
Gender:F
Credentials:PT, RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1926
Mailing Address - Country:US
Mailing Address - Phone:860-409-4595
Mailing Address - Fax:860-409-4860
Practice Address - Street 1:97 BARNES RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1885
Practice Address - Country:US
Practice Address - Phone:203-793-7592
Practice Address - Fax:203-793-7397
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006804CT01OtherANTHEM BLUE SHIELD
CT080006804CT02OtherANTHEM BC BS
CT080006804CT01OtherANTHEM BLUE SHIELD