Provider Demographics
NPI:1578074175
Name:DEPNER, AMY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:DEPNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 SIGMA RD STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 SIGMA RD STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4445
Practice Address - Country:US
Practice Address - Phone:972-756-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11304662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics