MEDICARE: AMY C TRUOG DPT

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
1	225100000X	Physical Therapist	12158	WI

General Provider Information

NPI Number	:	1487260774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY C TRUOG DPT

Provider Business Mailing Address
First Line	:	612 EASTERN AVE
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-4114
Country	:	US
Telephone Number	:	217-306-4864
Fax Number	:

Provider Business Practice Location Address
First Line	:	W227N16857 TILLIE LAKE CT
Second Line	:
City	:	JACKSON
State	:	WI
Zip	:	53037-9000
Country	:	US
Telephone Number	:	262-365-6170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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Directions to “ AMY C TRUOG DPT” Practice Location

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