Provider Demographics
NPI:1831463595
Name:AMG PHYSICAL REHABILITATION, LLC
Entity Type:Organization
Organization Name:AMG PHYSICAL REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER-LLC CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-338-6131
Mailing Address - Street 1:1601 E MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2387
Mailing Address - Country:US
Mailing Address - Phone:630-377-7505
Mailing Address - Fax:630-377-7532
Practice Address - Street 1:1601 E MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2387
Practice Address - Country:US
Practice Address - Phone:630-377-7505
Practice Address - Fax:630-377-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010382111NR0400X
208D00000X, 225100000X, 225200000X, 2255A2300X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty