Provider Demographics
NPI:1518677467
Name:ANDREA, AMY MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:ANDREA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:INDIAN CREEK
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4404
Mailing Address - Country:US
Mailing Address - Phone:847-345-7564
Mailing Address - Fax:
Practice Address - Street 1:7900 ROLLINS RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1512
Practice Address - Country:US
Practice Address - Phone:847-356-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009698225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant