Provider Demographics
NPI:1801626957
Name:STASH, AMELIA (DPT)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:
Last Name:STASH
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 1:2561 LAC DE VILLE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5645
Mailing Address - Country:US
Mailing Address - Phone:585-473-1290
Mailing Address - Fax:
Practice Address - Street 1:2561 LAC DE VILLE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5645
Practice Address - Country:US
Practice Address - Phone:585-473-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist