Provider Demographics
NPI:1518085547
Name:SEIDLE, AMY MAYS (LPTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MAYS
Last Name:SEIDLE
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 1:510 ROMANA DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-3435
Mailing Address - Country:US
Mailing Address - Phone:276-956-1805
Mailing Address - Fax:
Practice Address - Street 1:350 KINGS WAY RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-6631
Practice Address - Country:US
Practice Address - Phone:276-634-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23060000779225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant