Provider Demographics
NPI:1982977989
Name:LANCASTER, AMY M (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 FAIRMONT AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-5118
Mailing Address - Country:US
Mailing Address - Phone:304-363-8543
Mailing Address - Fax:304-363-0173
Practice Address - Street 1:719 FAIRMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-363-8543
Practice Address - Fax:304-363-0173
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist