Provider Demographics
NPI:1679742589
Name:AMY DORE DPT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AMY DORE DPT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF REIMBURSMENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-366-0403
Mailing Address - Street 1:1199 FOREST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5100
Mailing Address - Country:US
Mailing Address - Phone:831-643-9643
Mailing Address - Fax:
Practice Address - Street 1:1199 FOREST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5100
Practice Address - Country:US
Practice Address - Phone:831-643-9643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02879ZMedicare PIN