Provider Demographics
NPI:1104853720
Name:GREENFIELD, AMY M (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:SUNDEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:112 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1487
Mailing Address - Country:US
Mailing Address - Phone:715-635-3979
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:112 ASH ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1487
Practice Address - Country:US
Practice Address - Phone:715-635-3979
Practice Address - Fax:715-635-3990
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9895-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40376400Medicaid
WIP01820971OtherRAILROAD MEDICARE
WI40376400Medicaid