Provider Demographics
NPI:1457714461
Name:JO, AMY WASKE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:WASKE
Last Name:JO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BRIDGET
Other - Last Name:WASKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1818 TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1801
Mailing Address - Country:US
Mailing Address - Phone:315-244-3881
Mailing Address - Fax:
Practice Address - Street 1:1818 TRIPP AVE
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1801
Practice Address - Country:US
Practice Address - Phone:315-244-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012205L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist