Provider Demographics
NPI:1245665017
Name:MALTESE, AMBER PURDY (PT)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:PURDY
Last Name:MALTESE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:N
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:252-726-1802
Mailing Address - Fax:252-726-1805
Practice Address - Street 1:775 W CORBETT AVE STE 2
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8563
Practice Address - Country:US
Practice Address - Phone:252-726-1802
Practice Address - Fax:252-726-1805
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28363225100000X
WA61062888225100000X
NCP21735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP21735OtherPT LICENSE