Provider Demographics
NPI:1174743231
Name:MAYHEW, AMBER M (PT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:M
Other - Last Name:GASKILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1365 N BELSAY RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1602
Mailing Address - Country:US
Mailing Address - Phone:810-250-6112
Mailing Address - Fax:810-250-6113
Practice Address - Street 1:1365 N BELSAY RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1602
Practice Address - Country:US
Practice Address - Phone:810-250-6112
Practice Address - Fax:810-250-6113
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist