Provider Demographics
NPI:1619272895
Name:CORDER, AMY L (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:CORDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:BOOKLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:1200 W NORTHERN LIGHTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3652
Practice Address - Country:US
Practice Address - Phone:907-212-2090
Practice Address - Fax:907-212-2570
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2397225100000X
AKPHYP2481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist