Provider Demographics
NPI:1326023748
Name:MERRY, AMY M (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:MERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:101 WESTERVILLE PLZ
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2882
Practice Address - Country:US
Practice Address - Phone:614-791-8015
Practice Address - Fax:614-794-3552
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 003963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614488Medicaid
OH311356625029OtherCARESOURCE MCO
OH000000372031OtherANTHEM PROVIDER NUMBER
OH23-2804807OtherREHAB PROVIDER NETWORK
OH31-1356625OtherGREAT WEST PROVIDER NUMBE
OH685840OtherUHC
OH9400939OtherPHCS NETWORK
OH11648861OtherCAQH NUMBER
OHME4160941Medicare PIN