Provider Demographics
NPI:1619957743
Name:BRIGHTMAN, AMY LOUISE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:BRIGHTMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:EDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:1427 S WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMANCHE
Mailing Address - State:IA
Mailing Address - Zip Code:52730-1707
Mailing Address - Country:US
Mailing Address - Phone:563-259-4440
Mailing Address - Fax:563-259-1098
Practice Address - Street 1:1427 S WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CAMANCHE
Practice Address - State:IA
Practice Address - Zip Code:52730-1707
Practice Address - Country:US
Practice Address - Phone:563-259-4440
Practice Address - Fax:563-259-1098
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48795Medicare ID - Type UnspecifiedPHYSICAL THERAPIST