MEDICARE: AMY PEKARSKY NEVILLE AMY NEVILLE, 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	3439	SC

General Provider Information

NPI Number	:	1942531777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY PEKARSKY NEVILLE AMY NEVILLE, 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	:

Provider Business Practice Location Address
First Line	:	900 ISLAND PARK DR
Second Line	:	STE 105B
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7559
Country	:	US
Telephone Number	:	843-284-5285
Fax Number	:	843-593-9396

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

Provider Enumeration Date	:	01/18/2010
Last Update Date	:	05/24/2016

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