Provider Demographics
NPI:1609835743
Name:FLANNERY, AMY ELLEN (PT MS ATC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELLEN
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:PT MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886
Mailing Address - Country:US
Mailing Address - Phone:908-213-1603
Mailing Address - Fax:
Practice Address - Street 1:199 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-852-6600
Practice Address - Fax:908-852-6680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00424200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
31667Medicare ID - Type Unspecified