Provider Demographics
NPI:1609013150
Name:BATES, AMY (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W TOWN AND COUNTRY ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4615
Mailing Address - Country:US
Mailing Address - Phone:714-997-5518
Mailing Address - Fax:714-744-2650
Practice Address - Street 1:1111 W TOWN AND COUNTRY ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4615
Practice Address - Country:US
Practice Address - Phone:714-997-5518
Practice Address - Fax:714-744-2650
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist