Provider Demographics
NPI:1730486952
Name:LA RUE, AMY R (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:LA RUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:610-991-0234
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:9505 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4284
Practice Address - Country:US
Practice Address - Phone:703-680-0600
Practice Address - Fax:703-680-0790
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1086684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist