Provider Demographics
NPI:1790259505
Name:SMITH, AMY LYNN (PTA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:GOVEDNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1815 ALDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4015
Mailing Address - Country:US
Mailing Address - Phone:815-592-0522
Mailing Address - Fax:
Practice Address - Street 1:2115 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4741
Practice Address - Country:US
Practice Address - Phone:406-656-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.008020225200000X
MTPTP-PTA-LIC-13106225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant