Healthcare Provider Details

I. General information

NPI: 1629787957
Provider Name (Legal Business Name): AMA PEDIATRIC THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 W POLK ST STE G15
CHICAGO IL
60605-2768
US

IV. Provider business mailing address

363 E WACKER DR UNIT 3506
CHICAGO IL
60601-5815
US

V. Phone/Fax

Practice location:
  • Phone: 312-724-2354
  • Fax:
Mailing address:
  • Phone: 734-612-9092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALISON FREIER
Title or Position: PRESIDENT
Credential:
Phone: 734-612-9092