Healthcare Provider Details

I. General information

NPI: 1760744320
Provider Name (Legal Business Name): AMANDA L SCHABERG PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST SUITE 1205
CHICAGO IL
60611-2999
US

IV. Provider business mailing address

205 W WACKER DR SUITE 1020
CHICAGO IL
60606-1216
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-1112
  • Fax: 312-640-1011
Mailing address:
  • Phone: 312-640-0329
  • Fax: 312-640-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070019360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: