Provider Demographics
NPI:1831359264
Name:DETWEILER, AMY DUPREE (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DUPREE
Last Name:DETWEILER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:DUPREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:891 UINTA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6885
Practice Address - Country:US
Practice Address - Phone:508-766-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018703225100000X
NC11444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist