Provider Demographics
NPI:1669431003
Name:MIERZWA, AMY DIANE (DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:DIANE
Last Name:MIERZWA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7239 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6153
Mailing Address - Country:US
Mailing Address - Phone:980-224-7958
Mailing Address - Fax:980-224-7973
Practice Address - Street 1:7239 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6153
Practice Address - Country:US
Practice Address - Phone:980-224-7958
Practice Address - Fax:980-224-7973
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC346606Medicare ID - Type Unspecified