Provider Demographics
NPI:1508025008
Name:REESE, AMY PURVIS (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PURVIS
Last Name:REESE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13026 NC HIGHWAY 11 N
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-9592
Mailing Address - Country:US
Mailing Address - Phone:252-443-7667
Mailing Address - Fax:252-451-8136
Practice Address - Street 1:160 S WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3419
Practice Address - Country:US
Practice Address - Phone:252-443-7667
Practice Address - Fax:252-451-8136
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2125225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant