Provider Demographics
NPI:1811262835
Name:SMYSER, AMY THERESA (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:THERESA
Last Name:SMYSER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 E CANAL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3604
Mailing Address - Country:US
Mailing Address - Phone:717-845-2661
Mailing Address - Fax:
Practice Address - Street 1:1612 EAST CANAL ROAD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315
Practice Address - Country:US
Practice Address - Phone:717-845-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1000136225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant