Provider Demographics
NPI:1679969125
Name:AMBROSE, EMILY (MS, ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 6TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5553
Mailing Address - Country:US
Mailing Address - Phone:304-546-3681
Mailing Address - Fax:
Practice Address - Street 1:2918 6TH ST APT 3
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5553
Practice Address - Country:US
Practice Address - Phone:304-546-3681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer