Provider Demographics
NPI:1790752178
Name:SUMMERS, AMY JEAN (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:SUMMERS
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 1:2173 COUNTY HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-4172
Mailing Address - Country:US
Mailing Address - Phone:270-205-9724
Mailing Address - Fax:
Practice Address - Street 1:2100 W SOUTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565
Practice Address - Country:US
Practice Address - Phone:217-774-9660
Practice Address - Fax:214-774-9661
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.016443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0513607Medicare ID - Type Unspecified