Provider Demographics
NPI:1477660017
Name:AMSRUD, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:AMSRUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 HAMPTON PARK
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3160
Mailing Address - Country:US
Mailing Address - Phone:847-277-0771
Mailing Address - Fax:
Practice Address - Street 1:755 ELA RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2337
Practice Address - Country:US
Practice Address - Phone:847-550-9784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist