Provider Demographics
NPI:1063768661
Name:BRISKEY, AMY L (MPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BRISKEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:DIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:586-416-9103
Practice Address - Street 1:64541 VAN DYKE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48095-2570
Practice Address - Country:US
Practice Address - Phone:586-935-1100
Practice Address - Fax:586-935-1101
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist