Provider Demographics
NPI:1407140627
Name:GOLDSTEIN, AMY L (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3717 N RAVENSWOOD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3880
Mailing Address - Country:US
Mailing Address - Phone:773-770-3682
Mailing Address - Fax:773-305-7767
Practice Address - Street 1:3717 N RAVENSWOOD AVE STE 110
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3880
Practice Address - Country:US
Practice Address - Phone:773-770-3682
Practice Address - Fax:773-305-7767
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist