Provider Demographics
NPI:1568963437
Name:BARDEN, AMY SUE (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:BARDEN
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 1:3737 LANSING RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9773
Mailing Address - Country:US
Mailing Address - Phone:517-625-1111
Mailing Address - Fax:517-625-1152
Practice Address - Street 1:3737 LANSING RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9773
Practice Address - Country:US
Practice Address - Phone:517-625-1111
Practice Address - Fax:517-625-1152
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist