Provider Demographics
NPI:1912336629
Name:WANG, AMY ELINOR (PT)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELINOR
Last Name:WANG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7004 RIVERBEND CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-8543
Mailing Address - Country:US
Mailing Address - Phone:336-908-3669
Mailing Address - Fax:336-294-4004
Practice Address - Street 1:7004 RIVERBEND CT
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-8543
Practice Address - Country:US
Practice Address - Phone:336-908-3669
Practice Address - Fax:336-294-4004
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-03
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics