Provider Demographics
NPI:1659043180
Name:DULL, AMBER MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:DULL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:STARKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1918 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362
Mailing Address - Country:US
Mailing Address - Phone:410-829-2601
Mailing Address - Fax:
Practice Address - Street 1:40 WEST ELEVENTH AVENUE YORK, PA 17402
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-852-7733
Practice Address - Fax:717-852-7503
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003177225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATEI003177OtherCOMMONWEALTH OF PA