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NPI Code Detail

MEDICARE: AMY BOECKMANN PTA

MEDICARE: AMY BOECKMANN PTA
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
1225200000XPhysical Therapy AssistantIL

General Provider Information

NPI Number : 1972793784
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY BOECKMANN PTA
Provider Business Mailing Address
First Line : 48 N CLEVELAND ST
Second Line :
City : AVISTON
State : IL
Zip : 62216-3572
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 111 E ILLINOIS ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1850
Country : US
Telephone Number : 618-588-4924
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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