Provider Demographics
NPI:1972072619
Name:LIEB, AMY R (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:LIEB
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-1821
Mailing Address - Country:US
Mailing Address - Phone:941-626-6795
Mailing Address - Fax:
Practice Address - Street 1:4000 KINGS HWY
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8718
Practice Address - Country:US
Practice Address - Phone:941-255-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant