Provider Demographics
NPI:1790954568
Name:YADGIR, AMY E (PT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:YADGIR
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 1:5600 W BROWN DEER RD, STE 4
Mailing Address - Street 2:CENTER FOR BLIND & VISUALLY IMPAIRED CHILDREN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-355-3060
Mailing Address - Fax:414-355-3547
Practice Address - Street 1:5600 W BROWN DEER RD, STE 4
Practice Address - Street 2:CENTER FOR BLIND & VISUALLY IMPAIRED CHILDREN
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223
Practice Address - Country:US
Practice Address - Phone:414-355-3060
Practice Address - Fax:414-355-3547
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40258600Medicaid