MEDICARE: AMANDA MICHELLE HICKEY 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	070019286	IL

General Provider Information

NPI Number	:	1346502515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MICHELLE HICKEY PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	3852 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3622
Country	:	US
Telephone Number	:	773-355-5407
Fax Number	:	773-272-9144

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

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	10/12/2016

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Directions to “ AMANDA MICHELLE HICKEY PT” Practice Location

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