Provider Demographics
NPI:1679976500
Name:WIDENER, AMY (DPT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WIDENER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:WIDENER
Other - Middle Name:
Other - Last Name:STRUPCZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1338 BRISTOL PIKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5679
Mailing Address - Country:US
Mailing Address - Phone:215-633-9080
Mailing Address - Fax:215-633-9950
Practice Address - Street 1:1338 BRISTOL PIKE
Practice Address - Street 2:SUITE 203
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5679
Practice Address - Country:US
Practice Address - Phone:215-633-9080
Practice Address - Fax:215-633-9950
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist