Provider Demographics
NPI:1528027034
Name:SELF, AMY FRANCIS (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FRANCIS
Last Name:SELF
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 1:610 E CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2121
Mailing Address - Country:US
Mailing Address - Phone:615-849-8550
Mailing Address - Fax:615-849-8447
Practice Address - Street 1:610 E CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2121
Practice Address - Country:US
Practice Address - Phone:615-849-8550
Practice Address - Fax:615-849-8447
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446662Medicare ID - Type Unspecified