Provider Demographics
NPI:1568691632
Name:LONGSTAFF, AMY NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:LONGSTAFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HIGH RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-1462
Mailing Address - Country:US
Mailing Address - Phone:515-981-4269
Mailing Address - Fax:
Practice Address - Street 1:815 HIGH RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:IA
Practice Address - Zip Code:50211-1462
Practice Address - Country:US
Practice Address - Phone:515-981-4269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist