Provider Demographics
NPI:1427274869
Name:FEE, AMY BROOKE (DPT, OCS, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BROOKE
Last Name:FEE
Suffix:
Gender:F
Credentials:DPT, OCS, ATC, CSCS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BROOKE
Other - Last Name:PEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, OCS, ATC, CSCS
Mailing Address - Street 1:1448 15TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2756
Mailing Address - Country:US
Mailing Address - Phone:310-393-1703
Mailing Address - Fax:310-943-0462
Practice Address - Street 1:1448 15TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2756
Practice Address - Country:US
Practice Address - Phone:310-393-1703
Practice Address - Fax:310-943-0462
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27397225100000X, 2251S0007X, 2251X0800X
COCERT # 0994024032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08333ZOtherBLUE SHIELD
CA7521525OtherAETNA
CAW22042OtherMEDICARE PTAN
CO7030OtherPT LICENSE NUMBER
CAZZZ08333ZOtherBLUE SHIELD