Provider Demographics
NPI:1982816252
Name:HUMPHREY, AMY M (MSPT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:160 N POINTE BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4134
Mailing Address - Country:US
Mailing Address - Phone:717-569-4184
Mailing Address - Fax:717-569-4192
Practice Address - Street 1:700 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4700
Practice Address - Country:US
Practice Address - Phone:717-569-4184
Practice Address - Fax:717-569-4192
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052032932251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
2305203293OtherBLUECROSS BLUESHIELD
VA291437OtherANTHEM BCBS