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General NPI Number Information
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NPI Number | 1518018399
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Entity Type | Individual
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Provider Name | AMANDA AREVALO PT, MS, PCS
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6915 30TH PL
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City | BERWYN
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State | IL
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Zip | 60402-2957
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Country | US
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Telephone | 708-602-1581
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Fax | 708-484-8841
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Provider Business Mailing Address
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Address Line | 6915 30TH PL
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City | BERWYN
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State | IL
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Zip | 60402-2957
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Country | US
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Telephone | 708-602-1581
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Fax | 708-484-8841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State | IL
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