Provider Demographics
NPI:1013049402
Name:BEYER, AMY (LAT, WCMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BEYER
Suffix:
Gender:F
Credentials:LAT, WCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21140 W CAPITOL DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2953
Mailing Address - Country:US
Mailing Address - Phone:262-754-1650
Mailing Address - Fax:262-754-0877
Practice Address - Street 1:21140 W CAPITOL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2953
Practice Address - Country:US
Practice Address - Phone:262-754-1650
Practice Address - Fax:262-754-0877
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI305-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer