Provider Demographics
NPI:1780234187
Name:WEDGE, AMY (PT, DPT, NCS, CBIS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEDGE
Suffix:
Gender:F
Credentials:PT, DPT, NCS, CBIS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELLE
Other - Last Name:WEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-744-0172
Practice Address - Fax:252-744-0229
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC205RVOtherBCBS OF NC
NC1780234187Medicaid
NCQ65714AOtherMEDICARE