Provider Demographics
NPI:1184733818
Name:AMY FEE PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:AMY FEE PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:FEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT MPT ATC CSCS
Authorized Official - Phone:310-393-1703
Mailing Address - Street 1:3435 OCEAN PARK BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3318
Mailing Address - Country:US
Mailing Address - Phone:310-393-1703
Mailing Address - Fax:310-943-0462
Practice Address - Street 1:3435 OCEAN PARK BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3318
Practice Address - Country:US
Practice Address - Phone:310-393-1703
Practice Address - Fax:310-943-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7030225100000X
CA27397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ08333ZOtherBLUE SHIELD
0007251525OtherAETNA
ZZZ08333ZOtherBLUE SHIELD