Provider Demographics
NPI:1881351815
Name:NEWMAN, AMY JEROME (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEROME
Last Name:NEWMAN
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 1:21 QUEEN ANN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3705
Mailing Address - Country:US
Mailing Address - Phone:864-320-9094
Mailing Address - Fax:
Practice Address - Street 1:1500 TRAILHEAD CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-6226
Practice Address - Country:US
Practice Address - Phone:864-371-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty