Healthcare Provider Details

I. General information

NPI: 1184530172
Provider Name (Legal Business Name): AMELIA FLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 W MONTROSE AVE
CHICAGO IL
60618-1536
US

IV. Provider business mailing address

2432 W EASTWOOD AVE APT 1F
CHICAGO IL
60625-3772
US

V. Phone/Fax

Practice location:
  • Phone: 312-489-8579
  • Fax: 855-492-1591
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070040223
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: