MEDICARE: MRS. AMY AMELKOVICH 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		IL

General Provider Information

NPI Number	:	1396755567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY AMELKOVICH PT

Provider Business Mailing Address
First Line	:	500 PARK BLVD
Second Line	:	SUITE LL80C
City	:	ITASCA
State	:	IL
Zip	:	60143-3121
Country	:	US
Telephone Number	:	630-285-8007
Fax Number	:	630-285-8017

Provider Business Practice Location Address
First Line	:	1732 W ALGONQUIN RD
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-3405
Country	:	US
Telephone Number	:	847-637-1166
Fax Number	:	847-637-1167

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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