Provider Demographics
NPI:1861552234
Name:BIEDENBACH, AMY JO (PT MHS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:BIEDENBACH
Suffix:
Gender:F
Credentials:PT MHS
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:SOMMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:260-266-6013
Mailing Address - Fax:
Practice Address - Street 1:11143 PARKVIEW PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1728
Practice Address - Country:US
Practice Address - Phone:260-266-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008196A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
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