Healthcare Provider Details

I. General information

NPI: 1477694404
Provider Name (Legal Business Name): AMY FARLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 NOTRE DAME DR
LEMONT IL
60439-8527
US

IV. Provider business mailing address

639 N SPRING AVE
LA GRANGE PARK IL
60526-5541
US

V. Phone/Fax

Practice location:
  • Phone: 630-789-8962
  • Fax:
Mailing address:
  • Phone: 312-259-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070011559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: