MEDICARE: MRS. AMY LAMAR RANDOLPH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9987	TN
2	225100000X	Physical Therapist	070012738	IL

General Provider Information

NPI Number	:	1255344289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LAMAR RANDOLPH PT

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 W NORTH ST STE 101
Second Line	:
City	:	MANHATTAN
State	:	IL
Zip	:	60442-8177
Country	:	US
Telephone Number	:	815-478-7444
Fax Number	:	815-478-7447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/31/2025

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