Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2689 | AK |
N | 225100000X | Physical Therapist | 8213 | MN |
NPI | 1003076571 |
---|---|
Provider Name | Amy Lynn Sauck |
First Address | Wasilla, AK 99654-6563 |
Second Address | Wasilla, AK 99654-6563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 03/06/2014 |