Provider Demographics
NPI:1700187853
Name:APPLEWHITE, AMY SUELLEN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUELLEN
Last Name:APPLEWHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 LBJ FWY
Mailing Address - Street 2:APT# 2602
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-7121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6104 LBJ FWY
Practice Address - Street 2:APT# 2602
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-7121
Practice Address - Country:US
Practice Address - Phone:361-548-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2047124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant