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NPI Code Detail

MEDICARE: AMABELLE LEE BALOY DAVID RPT

MEDICARE: AMABELLE LEE BALOY DAVID RPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070017397IL

General Provider Information

NPI Number : 1245543362
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMABELLE LEE BALOY DAVID RPT
Provider Business Mailing Address
First Line : 2320 PEBBLESTONE WAY
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60490-5059
Country : US
Telephone Number : 815-677-0239
Fax Number :
Provider Business Practice Location Address
First Line : 6501 S CASS AVE
Second Line :
City : WESTMONT
State : IL
Zip : 60559-3200
Country : US
Telephone Number : 630-960-2026
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2010
Last Update Date : 07/18/2010

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