Provider Demographics
NPI:1962764969
Name:AMOS, EBONY JOI (LPTA)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:JOI
Last Name:AMOS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1325
Mailing Address - Country:US
Mailing Address - Phone:757-966-1451
Mailing Address - Fax:
Practice Address - Street 1:601 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-1325
Practice Address - Country:US
Practice Address - Phone:757-966-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601894225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant