Provider Demographics
NPI:1881251122
Name:BARANOSKI, AMY L
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BARANOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 QUARRY DR STE B23
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1153
Mailing Address - Country:US
Mailing Address - Phone:610-678-9949
Mailing Address - Fax:610-678-9636
Practice Address - Street 1:2209 QUARRY DR STE B23
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19609-1153
Practice Address - Country:US
Practice Address - Phone:610-678-9949
Practice Address - Fax:610-678-9636
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG010778225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1912098583OtherNPI