Provider Demographics
NPI:1750048567
Name:NERI, AMANDA ANNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ANNE
Last Name:NERI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 N CLARK ST STE 303
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5853
Mailing Address - Country:US
Mailing Address - Phone:773-339-5451
Mailing Address - Fax:
Practice Address - Street 1:1751 W DIVISION ST UNIT C-1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4086
Practice Address - Country:US
Practice Address - Phone:773-278-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0263552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic