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General NPI Number Information
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NPI Number | 1578961793
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Entity Type | Organization
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Legal Business Name | WENTZEL SHORE CAPITAL, INC
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 10719 DUNDEE RD
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City | HUNTLEY
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State | IL
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Zip | 60142-9706
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Country | US
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Telephone | 847-515-3366
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Fax | 847-515-3356
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Provider Business Mailing Address
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Address Line | 10719 DUNDEE RD
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City | HUNTLEY
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State | IL
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Zip | 60142-9706
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Country | US
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Telephone | 847-515-3366
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Fax | 847-515-3356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AMY D ZORNOW
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Credential | DPT
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Telephone | 847-515-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070006659
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070008677
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070006647
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070008735
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070020083
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License Number State | IL
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