Healthcare Provider Details

I. General information

NPI: 1831463595
Provider Name (Legal Business Name): AMG PHYSICAL REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E MAIN ST SUITE D
ST CHARLES IL
60174-2387
US

IV. Provider business mailing address

1601 E MAIN ST SUITE D
ST CHARLES IL
60174-2387
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-7505
  • Fax: 630-377-7532
Mailing address:
  • Phone: 630-377-7505
  • Fax: 630-377-7532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number038010382
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER A GARN
Title or Position: MANAGER-LLC CLINIC DIRECTOR
Credential: D.C.
Phone: 630-338-6131