Provider Demographics
NPI:1851467542
Name:MCCALLUMORE, AMY LYNN (DPT, OMPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:MCCALLUMORE
Suffix:
Gender:F
Credentials:DPT, OMPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2181 CUT CRYSTAL LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-2804
Mailing Address - Country:US
Mailing Address - Phone:586-219-9560
Mailing Address - Fax:
Practice Address - Street 1:15979 HALL RD STE 150
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5362
Practice Address - Country:US
Practice Address - Phone:586-416-8439
Practice Address - Fax:586-416-8440
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
MI5501011655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic