Provider Demographics
NPI:1710009428
Name:BRODSKY, AMY B (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:684 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2129
Practice Address - Country:US
Practice Address - Phone:630-617-5489
Practice Address - Fax:630-617-5723
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCJ4383OtherR.R. MEDICARE GROUP#
IL1619908OtherBCBS IL GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
IL367885100OtherUS DEPT OF LABOR
IL1623066OtherBCBS PROVIDER #
ILF400238413Medicare PIN
IL568080OtherMEDICARE GROUP NUMBER
IL200852Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL206147131Medicare PIN
IL367885100OtherUS DEPT OF LABOR