Provider Demographics
NPI:1255110581
Name:KINNEY, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 LONG MARY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:PA
Mailing Address - Zip Code:18833-7759
Mailing Address - Country:US
Mailing Address - Phone:570-721-0456
Mailing Address - Fax:
Practice Address - Street 1:640 DR MARY MCLEOD BETHUNE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3012
Practice Address - Country:US
Practice Address - Phone:386-481-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20000358912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer