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NPI Code Detail

MEDICARE: AMY NATHAN DPT

MEDICARE: AMY NATHAN DPT
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
1225100000XPhysical Therapist041895-1
2225100000XPhysical Therapist070.025226IL

General Provider Information

NPI Number : 1770001786
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY NATHAN DPT
Provider Business Mailing Address
First Line : 3240 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3414
Country : US
Telephone Number : 773-281-4220
Fax Number :
Provider Business Practice Location Address
First Line : 3240 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-3414
Country : US
Telephone Number : 773-281-4220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2017
Last Update Date : 07/25/2021

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