Provider Demographics
NPI:1871125427
Name:GOLDEN, AMELIE (DPT)
Entity type:Individual
Prefix:
First Name:AMELIE
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMELIE
Other - Middle Name:
Other - Last Name:BRUYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1450 NORTHWEST BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5605
Mailing Address - Country:US
Mailing Address - Phone:208-667-6264
Mailing Address - Fax:208-664-4313
Practice Address - Street 1:1088 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8741
Practice Address - Country:US
Practice Address - Phone:208-772-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist