Provider Demographics
NPI:1114552494
Name:VOGEL, AMY LYNN (MPT, PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:VOGEL
Suffix:
Gender:F
Credentials:MPT, PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RYAN
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT, PT
Mailing Address - Street 1:1531 WELTON CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4168
Mailing Address - Country:US
Mailing Address - Phone:248-978-4626
Mailing Address - Fax:
Practice Address - Street 1:1531 WELTON CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4168
Practice Address - Country:US
Practice Address - Phone:248-978-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist