Provider Demographics
NPI:1720817513
Name:HARRELL, AMY (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:2804 TAMARACK TRL
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4938
Mailing Address - Country:US
Mailing Address - Phone:856-332-3730
Mailing Address - Fax:
Practice Address - Street 1:4301 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3115
Practice Address - Country:US
Practice Address - Phone:856-332-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL45712081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine