Provider Demographics
NPI:1609264076
Name:AMRAM, SHAENA MAE G (DPT)
Entity Type:Individual
Prefix:
First Name:SHAENA MAE
Middle Name:G
Last Name:AMRAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SHAENA MAE
Other - Middle Name:SAZON
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2600 COMPASS ROAD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:877-787-3422
Mailing Address - Fax:847-441-4130
Practice Address - Street 1:7540 SMOKE RANCH ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:725-241-5608
Practice Address - Fax:224-661-6548
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41468225100000X
NV2678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist