Provider Demographics
NPI:1841257771
Name:BRILL, AMY CLARE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:CLARE
Last Name:BRILL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:THROOP
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1129
Mailing Address - Country:US
Mailing Address - Phone:570-487-1291
Mailing Address - Fax:
Practice Address - Street 1:1212 ONEILL HWY
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1717
Practice Address - Country:US
Practice Address - Phone:570-969-1162
Practice Address - Fax:570-969-1167
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011967750001Medicaid
PA1011967750001Medicaid