Provider Demographics
NPI:1700564499
Name:PRESTON, AMY J (CEP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:J
Last Name:PRESTON
Suffix:
Gender:F
Credentials:CEP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10420 NOGGLES RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9658
Mailing Address - Country:US
Mailing Address - Phone:734-732-3291
Mailing Address - Fax:
Practice Address - Street 1:5325 ELLIOTT DR STE 105
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8637
Practice Address - Country:US
Practice Address - Phone:734-712-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI660302224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist