Provider Demographics
NPI:1871631697
Name:GILLEY, AMY (PT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:GILLEY
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 1:1245 WOODSDALE FARM DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-5772
Mailing Address - Country:US
Mailing Address - Phone:502-921-9702
Mailing Address - Fax:
Practice Address - Street 1:9510 ORMSBY STATION RD
Practice Address - Street 2:100B
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4081
Practice Address - Country:US
Practice Address - Phone:502-753-5060
Practice Address - Fax:502-253-4145
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist