Provider Demographics
NPI:1841737129
Name:NEUHARTH, AUTUMN (PT)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:NEUHARTH
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 1:211 N CLINTON ST STE 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1283
Mailing Address - Country:US
Mailing Address - Phone:877-709-1090
Mailing Address - Fax:866-221-3400
Practice Address - Street 1:1049 LAKE ST STE 201
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301
Practice Address - Country:US
Practice Address - Phone:877-709-1090
Practice Address - Fax:866-221-3400
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist