Amy L Queen, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

002082 Issued in WV

Practice address

60 Clarksburg Rd
Buckhannon, WV 26201-8400

Phone

(304) 472-0181

Fax

(304) 472-0192

NPI assigned

Jun 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Country Roads Physical Therapy and RehabilitationGroup PAC ID 5597835603, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Country Roads Physical Therapy and Rehabilitation

  • Physical Therapist
  • Fairmont, WV
  • NPI 1831147297
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382659200000",
    "number": "1871537381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "943 MAPLE DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265052812",
            "telephone_number": "304-599-2515",
            "fax_number": "304-285-3738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 CLARKSBURG RD",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262018400",
            "telephone_number": "304-472-0181",
            "fax_number": "304-472-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2013-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "002082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7304067000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Proctor
• Prosperous Play Therapies, LLC
• Joseph Puffenbarger
• April Nicole Pugh
• Cindy Louise Pugh
• Ellen Radabaugh
• Marlene Radan
• Rebecca Ann Radcliff, RN
• Elizabeth Rankin
• Suzanne Marie Ratliff

• Physical Therapist in Buckhannon, WV
• Providers in Buckhannon, WV by specialty
• Physical Therapist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.