Provider Demographics
NPI:1104129857
Name:AMEY, TYREINA BENISHA (PTA)
Entity type:Individual
Prefix:MRS
First Name:TYREINA
Middle Name:BENISHA
Last Name:AMEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HOOD ROAD
Mailing Address - Street 2:APT 21
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8419
Mailing Address - Country:US
Mailing Address - Phone:510-213-4141
Mailing Address - Fax:
Practice Address - Street 1:1429 W FREMONT ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2635
Practice Address - Country:US
Practice Address - Phone:209-546-0944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATA9317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant