Provider Demographics
NPI:1871030197
Name:HILL, AMBER RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RODRIGUEZ
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RODRIGUEZ
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2930 W HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2610
Mailing Address - Country:US
Mailing Address - Phone:541-784-7771
Mailing Address - Fax:541-672-1466
Practice Address - Street 1:2930 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2610
Practice Address - Country:US
Practice Address - Phone:541-784-7771
Practice Address - Fax:541-672-1466
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08853261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy