Basic Information
| Provider Information | |||||||||
| NPI: | 1497787709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMBURY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24569 ROUTE 6 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TOWANDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188488254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702651111 | ||||||||
| FaxNumber: | 5702657134 | ||||||||
| Practice Location | |||||||||
| Address1: | 24569 ROUTE 6 | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TOWANDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 188488254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702651111 | ||||||||
| FaxNumber: | 5702657422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 10/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT006899L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.