Provider Demographics
NPI:1932410818
Name:OSBORNE, AMY D
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:OSBORNE
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 1:5393 E OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-9165
Mailing Address - Country:US
Mailing Address - Phone:812-743-2546
Mailing Address - Fax:
Practice Address - Street 1:1712 LELAND DR
Practice Address - Street 2:THE WATERS OF HUNTINBURG
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542
Practice Address - Country:US
Practice Address - Phone:812-683-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001318A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant