Provider Demographics
NPI:1659481737
Name:AMICK, CHRISTOPHER JOHN (PT MS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:AMICK
Suffix:
Gender:M
Credentials:PT MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2332 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-288-1494
Mailing Address - Fax:
Practice Address - Street 1:1047 CENTURY DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3772
Practice Address - Country:US
Practice Address - Phone:618-307-3434
Practice Address - Fax:618-307-3435
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95234Medicare ID - Type Unspecified