Provider Demographics
NPI:1700922960
Name:PHIPPS-POE, AMY LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:PHIPPS-POE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:PHIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1503 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1102
Mailing Address - Country:US
Mailing Address - Phone:218-834-2586
Mailing Address - Fax:218-834-2587
Practice Address - Street 1:1503 7TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1102
Practice Address - Country:US
Practice Address - Phone:218-834-2586
Practice Address - Fax:218-834-2587
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5707OtherSTATE OF MN BOARD OF PT
WI5707OtherSTATE OF WI BOARD OF PT
WI5707OtherSTATE OF WI BOARD OF PT