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General NPI Number Information
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NPI Number | 1861304412
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Entity Type | Organization
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Legal Business Name | AMANDA IMYAK PLLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 2132 GREEN BAY RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2431
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Country | US
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Telephone | 847-404-8078
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Fax |
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Provider Business Mailing Address
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Address Line | 725 SMOKE TREE RD
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City | DEERFIELD
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State | IL
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Zip | 60015-4556
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Country | US
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Telephone | 847-404-8078
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. AMANDA IMYAK
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Credential | DPT
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Telephone | 847-404-8078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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