Provider Demographics
NPI:1548380793
Name:PARSONS, AMY LYNNE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:PARSONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 KARMEL ST
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1675
Mailing Address - Country:US
Mailing Address - Phone:518-231-4192
Mailing Address - Fax:
Practice Address - Street 1:3075 ENTERPRISE DR STE 200
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3241
Practice Address - Country:US
Practice Address - Phone:518-231-4192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016321225100000X
NY018514-1225100000X
PAPT016321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017296860001Medicaid