Provider Demographics
NPI:1760634646
Name:STANISLAW, AMY E (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:STANISLAW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:KRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:326 KINDT CORNER RD.
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 ELIZABETH AVE.
Practice Address - Street 2:
Practice Address - City:LAURELDALE
Practice Address - State:PA
Practice Address - Zip Code:19605
Practice Address - Country:US
Practice Address - Phone:610-921-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO14297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist