Provider Demographics
NPI:1205007739
Name:PISCHE, AMBER (DPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PISCHE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:KRUMPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 N SHEFFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2215
Mailing Address - Country:US
Mailing Address - Phone:773-575-5701
Mailing Address - Fax:
Practice Address - Street 1:2400 N SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2215
Practice Address - Country:US
Practice Address - Phone:773-575-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist