Provider Demographics
NPI:1588741524
Name:FLINN, AMY MERRY (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MERRY
Last Name:FLINN
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 1:650 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-649-0700
Mailing Address - Fax:916-649-2087
Practice Address - Street 1:650 UNIVERSITY AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-649-0700
Practice Address - Fax:916-649-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 25946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT259460Medicare PIN
CAOPT259461Medicare ID - Type Unspecified