Provider Demographics
NPI:1508024720
Name:CARLISLE, AMY SIMS (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SIMS
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HUMMINGBIRD LOOP
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-7886
Mailing Address - Country:US
Mailing Address - Phone:901-592-7818
Mailing Address - Fax:
Practice Address - Street 1:765 BERT JOHNSTON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2414
Practice Address - Country:US
Practice Address - Phone:901-475-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist