Provider Demographics
NPI:1972636934
Name:HEALY, AMY (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HEALY
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 1:124 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2027
Mailing Address - Country:US
Mailing Address - Phone:508-651-1504
Mailing Address - Fax:
Practice Address - Street 1:150 A ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2807
Practice Address - Country:US
Practice Address - Phone:781-444-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66500OtherBLUE CROSS BLUE SHIELD
MAY69495Medicare ID - Type Unspecified