Provider Demographics
NPI:1447694369
Name:OSTROM, AIMEE M (MPT)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:OSTROM
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 1:50 E DUVAL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4153
Mailing Address - Country:US
Mailing Address - Phone:520-648-0270
Mailing Address - Fax:
Practice Address - Street 1:50 E DUVAL RD STE 10
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4153
Practice Address - Country:US
Practice Address - Phone:520-648-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist