Provider Demographics
NPI:1790228609
Name:AMON, BETH (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:AMON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 KITTERY CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-6317
Mailing Address - Country:US
Mailing Address - Phone:239-258-7771
Mailing Address - Fax:
Practice Address - Street 1:7117 CONGDON RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4234
Practice Address - Country:US
Practice Address - Phone:239-703-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18994225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant