Provider Demographics
NPI:1629255039
Name:GANN, AMY MIDDLETON (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MIDDLETON
Last Name:GANN
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 1:8013 BARTONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9676
Mailing Address - Country:US
Mailing Address - Phone:336-643-2721
Mailing Address - Fax:
Practice Address - Street 1:2309 W CONE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4045
Practice Address - Country:US
Practice Address - Phone:336-545-9609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist