Provider Demographics
NPI:1992316806
Name:AMP MOVEMENT THERAPY
Entity type:Organization
Organization Name:AMP MOVEMENT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCHUR
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:913-645-0703
Mailing Address - Street 1:3026 THOMAS AVE APT H
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3525
Mailing Address - Country:US
Mailing Address - Phone:913-645-0703
Mailing Address - Fax:
Practice Address - Street 1:4715 IBERIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-5507
Practice Address - Country:US
Practice Address - Phone:913-645-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy