Provider Demographics
NPI:1609016823
Name:ENTREKIN, AMY ANN (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANN
Last Name:ENTREKIN
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 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:5623 NW 86TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2956
Practice Address - Country:US
Practice Address - Phone:515-270-0303
Practice Address - Fax:515-270-0160
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist