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NPI Code Detail

MEDICARE: MS. AMY LYN MCANDREW PTA

MEDICARE: MS. AMY LYN MCANDREW PTA
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
1225200000XPhysical Therapy Assistant160004669IL

General Provider Information

NPI Number : 1285276410
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY LYN MCANDREW PTA
Provider Business Mailing Address
First Line : 6533 N NEVA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60631-1677
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1551 LAKE COOK RD
Second Line :
City : DEERFIELD
State : IL
Zip : 60015-5651
Country : US
Telephone Number : 847-236-7760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2019
Last Update Date : 10/09/2019

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