Provider Demographics
NPI:1205340528
Name:HEVENER, AMY K W (PT, DPT, FMSC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K W
Last Name:HEVENER
Suffix:
Gender:F
Credentials:PT, DPT, FMSC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:K
Other - Last Name:WHATLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, FMSC
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:2275 BEECH AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-3101
Practice Address - Country:US
Practice Address - Phone:540-466-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist