Provider Demographics
NPI:1457607525
Name:KLOOSTER, AMY S (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:KLOOSTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:S
Other - Last Name:PECAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12086 ASHCROFT PLACE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-733-1893
Mailing Address - Fax:317-733-1894
Practice Address - Street 1:12086 ASHCROFT PL
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8901
Practice Address - Country:US
Practice Address - Phone:317-733-1893
Practice Address - Fax:317-733-1894
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005834A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist