Provider Demographics
NPI:1700017670
Name:THOMAS, AMBER (DPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3597 KESWICK DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2003
Mailing Address - Country:US
Mailing Address - Phone:407-923-0299
Mailing Address - Fax:
Practice Address - Street 1:3597 KESWICK DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-2003
Practice Address - Country:US
Practice Address - Phone:407-923-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0096792251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics