Provider Demographics
NPI:1245369982
Name:VERNON, AMY HALL (MSPT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HALL
Last Name:VERNON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10325 WOODSTREAM CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7335
Mailing Address - Country:US
Mailing Address - Phone:407-306-0450
Mailing Address - Fax:407-647-6415
Practice Address - Street 1:1211 PALMETTO AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4913
Practice Address - Country:US
Practice Address - Phone:407-647-4740
Practice Address - Fax:407-647-6415
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT197682251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics