Provider Demographics
NPI:1689087314
Name:SMITH, AMBER (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 LINCOLN AVE.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:N. CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-3610
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:3109 UNIVERSITY AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-241-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225100000X
WVPT00308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist