Provider Demographics
NPI:1811045099
Name:AMELOTTE, AMY MELISSA (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MELISSA
Last Name:AMELOTTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9181 STRATHCONA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5218
Mailing Address - Country:US
Mailing Address - Phone:714-964-4865
Mailing Address - Fax:
Practice Address - Street 1:18800 MAIN ST STE 208
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1718
Practice Address - Country:US
Practice Address - Phone:714-841-6162
Practice Address - Fax:714-841-9912
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT21826AMedicare ID - Type Unspecified