MEDICARE: AMY A LOHAN 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	070014202	IL
2	2251S0007X	Sports Physical Therapist	070014202	IL
3	2251X0800X	Orthopedic Physical Therapist	070104202	IL

General Provider Information

NPI Number	:	1891868907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY A LOHAN PT

Provider Business Mailing Address
First Line	:	10255 SOUTHWEST HWY
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1350
Country	:	US
Telephone Number	:	708-903-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	10255 SOUTHWEST HWY
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1350
Country	:	US
Telephone Number	:	708-903-4105
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	05/06/2016

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Directions to “ AMY A LOHAN PT” Practice Location

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