Provider Demographics
NPI:1538337043
Name:DRUM, AMY LYDIA (MSPT)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYDIA
Last Name:DRUM
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 8TH AVE
Mailing Address - Street 2:APT 3-H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1767
Mailing Address - Country:US
Mailing Address - Phone:718-789-8879
Mailing Address - Fax:
Practice Address - Street 1:149 MADISON AVE
Practice Address - Street 2:RENEW PHYSICAL THERAPY STE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6713
Practice Address - Country:US
Practice Address - Phone:212-213-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027961OtherNEW YORK STATE LICENSE