Provider Demographics
NPI:1013126598
Name:AMASH, JERRY JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:JOSEPH
Last Name:AMASH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-8702
Mailing Address - Country:US
Mailing Address - Phone:336-449-9384
Mailing Address - Fax:
Practice Address - Street 1:1002 N CHURCH ST STE 1
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1440
Practice Address - Country:US
Practice Address - Phone:336-379-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist