Provider Demographics
NPI:1336180645
Name:THARP, AMY M (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:THARP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 LIRON AVE
Mailing Address - Street 2:# 204
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-7859
Mailing Address - Country:US
Mailing Address - Phone:239-481-0761
Mailing Address - Fax:
Practice Address - Street 1:4223 LIRON AVE
Practice Address - Street 2:# 204
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-7859
Practice Address - Country:US
Practice Address - Phone:239-481-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist