Provider Demographics
NPI:1063825560
Name:SWAIN, AMY (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1256 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6568
Mailing Address - Country:US
Mailing Address - Phone:630-378-9420
Mailing Address - Fax:630-378-9169
Practice Address - Street 1:1256 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6568
Practice Address - Country:US
Practice Address - Phone:630-378-9420
Practice Address - Fax:630-378-9169
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist