Provider Demographics
NPI:1821682287
Name:COMER, AMY (LPTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:COMER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 HIGH ROCK TRL
Mailing Address - Street 2:
Mailing Address - City:VERNON HILL
Mailing Address - State:VA
Mailing Address - Zip Code:24597-3226
Mailing Address - Country:US
Mailing Address - Phone:434-470-6141
Mailing Address - Fax:
Practice Address - Street 1:1191 HIGH ROCK TRL
Practice Address - Street 2:
Practice Address - City:VERNON HILL
Practice Address - State:VA
Practice Address - Zip Code:24597-3226
Practice Address - Country:US
Practice Address - Phone:434-470-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601824225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2306601824OtherVIRGINIA BOARD OF PHYSICAL THERAPY