Provider Demographics
NPI:1952416513
Name:GRIFFIN, AMY M (MS, PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 GOODYEAR AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5804
Mailing Address - Country:US
Mailing Address - Phone:805-339-9718
Mailing Address - Fax:805-339-9728
Practice Address - Street 1:1623 GOODYEAR AVE
Practice Address - Street 2:UNIT D
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5804
Practice Address - Country:US
Practice Address - Phone:805-339-9718
Practice Address - Fax:805-339-9728
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA277842251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ62926ZOtherBS OF CA
CA714483OtherUNITED HEALTHCARE
CAZZZ62926ZOtherBS OF CA