Provider Demographics
NPI:1871168708
Name:BRILEY, AMY LYNN (PT/DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BRILEY
Suffix:
Gender:F
Credentials:PT/DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8316
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-8316
Mailing Address - Country:US
Mailing Address - Phone:541-241-2104
Mailing Address - Fax:971-242-4088
Practice Address - Street 1:64745 MELINDA CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8828
Practice Address - Country:US
Practice Address - Phone:541-241-2104
Practice Address - Fax:971-242-4088
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist