Provider Demographics
NPI:1982034450
Name:URVAND, AMBER LEA (DPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEA
Last Name:URVAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LEA
Other - Last Name:URVAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730
Mailing Address - Country:US
Mailing Address - Phone:701-965-6384
Mailing Address - Fax:701-965-4258
Practice Address - Street 1:702 1ST ST SW
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730
Practice Address - Country:US
Practice Address - Phone:701-965-6384
Practice Address - Fax:701-965-4258
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-2473225100000X
ND1698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist