MEDICARE: MRS. AMISHA KLAWONN PT, DPT, OCS

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	5353	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861499642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMISHA KLAWONN PT, DPT, OCS

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 E. HIGHLAND
Second Line	:	#200
City	:	PHOENIX
State	:	AZ
Zip	:	85016
Country	:	US
Telephone Number	:	623-979-0066
Fax Number	:	623-979-0052

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/13/2025

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