Provider Demographics
NPI:1063591287
Name:AMYX, DONNA J (CERTIFIED FITTER)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:AMYX
Suffix:
Gender:F
Credentials:CERTIFIED FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709
Mailing Address - Country:US
Mailing Address - Phone:208-377-1838
Mailing Address - Fax:208-375-7251
Practice Address - Street 1:6029 KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-377-1838
Practice Address - Fax:208-375-7251
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID00251176S224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0277240001Medicare ID - Type Unspecified