Provider Demographics
NPI:1861766966
Name:ALLAIRE, AMY DEANN (MPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DEANN
Last Name:ALLAIRE
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:PO BOX 4649
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-0054
Mailing Address - Country:US
Mailing Address - Phone:512-267-5400
Mailing Address - Fax:512-267-5700
Practice Address - Street 1:502 CRYSTAL FALLS PKWY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1959
Practice Address - Country:US
Practice Address - Phone:512-528-0800
Practice Address - Fax:512-528-0460
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1136158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist