Provider Demographics
NPI:1265755789
Name:PIHLSTROM, AMY (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:PIHLSTROM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:AGNEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:125 N PARKSIDE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6097
Mailing Address - Country:US
Mailing Address - Phone:719-785-3722
Mailing Address - Fax:
Practice Address - Street 1:125 N PARKSIDE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6097
Practice Address - Country:US
Practice Address - Phone:719-785-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist