Provider Demographics
NPI:1801926118
Name:NEEBLE, AMY LYNN (MPT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:NEEBLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 IRENE LN.
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9529
Mailing Address - Country:US
Mailing Address - Phone:336-644-9677
Mailing Address - Fax:336-644-6242
Practice Address - Street 1:7802 IRENE LN.
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9529
Practice Address - Country:US
Practice Address - Phone:336-644-9677
Practice Address - Fax:336-644-6242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210711Medicaid