Provider Demographics
NPI:1649216094
Name:BAXTER, AMY E (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2628
Mailing Address - Country:US
Mailing Address - Phone:315-558-2197
Mailing Address - Fax:315-638-1421
Practice Address - Street 1:606 OLD ROUTE 17
Practice Address - Street 2:DISCOVERY HEALTH CENTER
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0216041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY89336OtherGHI HMO
NY6697102OtherGHI PPO