Provider Demographics
NPI:1518785112
Name:BARLAGE, AMY SUZANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUZANNE
Last Name:BARLAGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:SUZANNE
Other - Last Name:BARLAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5139 MOHR VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3755
Mailing Address - Country:US
Mailing Address - Phone:248-840-7426
Mailing Address - Fax:
Practice Address - Street 1:4401 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6516
Practice Address - Country:US
Practice Address - Phone:248-566-3525
Practice Address - Fax:248-566-3527
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010112992251N0400X, 2251X0800X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic