Healthcare Provider Details

I. General information

NPI: 1659481737
Provider Name (Legal Business Name): CHRISTOPHER JOHN AMICK PT MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 CENTURY DR
EDWARDSVILLE IL
62025-3772
US

IV. Provider business mailing address

2332 WESTCHESTER DR
MARYVILLE IL
62062
US

V. Phone/Fax

Practice location:
  • Phone: 618-307-3434
  • Fax: 618-307-3435
Mailing address:
  • Phone: 618-288-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070013064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: