Provider Demographics
NPI:1215977905
Name:DRISCOLL, AMY E (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:DRISCOLL
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 1:5630 E SANTA ANA CANYON RD
Mailing Address - Street 2:#150
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3122
Mailing Address - Country:US
Mailing Address - Phone:714-282-7701
Mailing Address - Fax:
Practice Address - Street 1:5630 E SANTA ANA CANYON RD
Practice Address - Street 2:#150
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3122
Practice Address - Country:US
Practice Address - Phone:714-282-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17215CMedicare PIN
CAW17215BMedicare PIN
CAFX572YMedicare PIN
CAFX572ZMedicare PIN